Nearly nine out of 10 upstate New Yorkers have no medical reason to have their vitamin D levels tested, yet health care providers and patients continue to frequently request the test, according to an analysis by Excellus BlueCross BlueShield.
Last year, according to Excellus, 641,000 upstate New Yorkers had their vitamin D levels tested, and about 42 percent did so without a medical indication for it. Typically, only people with certain conditions, including, but not limited to, osteoporosis, kidney and liver disease, malabsorption syndromes, bone disorders and certain endocrine conditions, are candidates for testing. Older adults, and some pregnant or lactating women, can also expect to have their doctors recommend vitamin D testing, Excellus officials said.
“Even with a medical indication to test for vitamin D deficiency, it’s valid to question the need for the test, because the outcome won’t necessarily change the treatment,” stated Marybeth McCall M.D., vice president and chief medical officer of Excellus. “If your doctor suspects a low vitamin D level, taking an over-the-counter supplement, or getting more vitamin D from your diet may be sufficient.”
McCall said widespread testing is associated with potentially unnecessary treatments, which can lead to supplements, retesting and increased medical costs. In addition, she said, on average, a vitamin D deficiency test, typically covered by health insurance, can cost $50.
In 2014, in upstate New York, an estimated $33 million was spent on vitamin D testing, according to an Excellus BlueCross BlueShield infographic called “Vitamin D Tests.” In addition, according to McCall, high-dose, prescription-strength vitamin D supplements may also have an out-of-pocket cost for the patient, depending on his or her level of health insurance coverage.
Essentially, Vitamin D is a vitamin which helps our bodies absorb calcium, keeping bones and muscles — including the heart — healthy.
However, “Most people get enough vitamin D through the foods they eat and the time they spend in the sun,” McCall stated. “Past studies have linked vitamin D deficiency to numerous conditions, such as heart disease and cancer, so patients and physicians started demanding more tests. A more recent critical analysis of these reports shows significant flaws, leading many in the medical community to question the necessity of widespread testing.”
According to McCall, the U.S. Preventive Services Task Force recently found the current medical evidence insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults.
Nonetheless, the American Society of Clinical Pathology contributed the following recommendation to the “Choosing Wisely” initiative:
“Many people have low levels of vitamin D, but few have seriously low levels. Most of us don’t need a vitamin D test. We just need to make simple changes so we get enough vitamin D.”
McCall said “Choosing Wisely” is an American Board of Internal Medicine (ABIM) Foundation initiative which includes more than 300 care recommendations submitted by physician-led medical specialty societies to improve the quality of care, and encourage conversations between physicians and patients about services that may be unnecessary, and may cause harm.
She noted that the recommended daily vitamin D intake through food and/or supplements is 600 international units for those 70 years and younger, and 800 international units for those older than age 70.
“To ensure that you actually consume the recommended amount, it may not hurt to take a multivitamin or vitamin D supplement,” she stated.
In addition, aside from multivitamins and vitamin D supplements, the Excellus infographic also lists cod liver oil, salmon and tuna as foods high in vitamin D. Other, more commonly consumed foods, such as milk, cereal and orange juice, are usually fortified with vitamin D, according to the info graphic.
Excellus said our bodies can also produce all of the vitamin D we need throughout the year by getting five to 30 minutes of sun twice a week during the spring, summer and fall. However, the U.S. Preventive Services Task Force doesn’t recommend sun exposure as a way to boost vitamin D levels, because it increases the risk for skin cancer.
“The reality is that only about one in ten upstate New Yorkers has a medical reason to be tested,” stated McCall, adding that it is difficult to determine what a normal vitamin D level is. People who have darker skin pigmentation can have low levels of vitamin D, as can individuals whose body mass index categorizes them as obese.
McCall said it’s unclear whether the low levels of vitamin D are linked with adverse health outcomes.
“The medical evidence for any benefits of routine testing for vitamin D deficiency in healthy adults and children is insufficient,” she concluded. “Excellus BlueCross BlueShield’s goal in reviewing the data, and publishing an infographic on the subject, is to encourage informed discussions between patients and their doctors.”
To view the infographic, go to: http://bit.ly/1Idyod5
To view a video on the topic, go to YouTube.com/ExcellusBCBS
In addition, for information regarding “Choosing Wisely” at Consumer Reports, go to: