More than half of Medicare beneficiaries undergoing cataract surgery have at least one preoperative test, despite published guidelines against this testing, according to a study published April 16 in the New England Journal of Medicine. The authors say clinicians’ lack of adherence to guidelines results in substantial, unnecessary Medicare expenses. To assess current prevalence and cost of preoperative testing, the researchers used claims from 440,857 Medicare beneficiaries (66 years of age and older) undergoing cataract surgery in 2011. Tests were classified as preoperative if ordered within 30 days of surgery and included: complete blood count, chemical analysis, coagulation studies, urinalysis, electrocardiography, echocardiography, cardiac stress tests, chest radiography, and pulmonary-function tests, as well as components of standard laboratory panels. The researchers found that roughly half of all beneficiaries underwent at least one preoperative test (53 percent). Patient characteristics were similar between those having and not having a preoperative test. Compared to the 11-month baseline period, the mean number of tests per beneficiary during the preoperative month increased by 66 percent. While 13 percent of patients underwent one test during the preoperative month, 11 percent underwent two, 10 percent underwent three, 7 percent underwent four, and 13 percent underwent five or more. […]