Medical treatment excesses examined
San Diego conference casts light on growing medical overuse trend
By Paul Sisson
More testing.
More surgeries.
More technology.
For decades, the measuring stick for medical progress has been doing more.
But while modern medicine has regularly delivered amazing new treatments, there is growing concern that some procedures are overused.
Simmering since the late 1970s, the push for reform became very real in 2010 with passage of the Affordable Care Act. The law includes provisions aimed squarely at medical overuse, which studies have shown can harm patients and drive up health care costs.
Last week, hundreds of medical experts gathered at the Omni Hotel in downtown San Diego to discuss ways to make sure patients are getting the right amount of care when they need it — without having to undergo unnecessary procedures or missing out on early interventions that could head off bigger problems later on.
Organized by the Boston-based Lown Institute, the symposium brought together doctors, patients and their advocates from across the nation.
“The core problem, I think, is that what people want is health, not necessarily health care, but what the system incentivizes is more health care,” said Dr. Vikas Saini, the institute’s president.
The medical establishment has paid increasing attention to the topic. In 2010, the Institute of Medicine estimated that about $210 billion is wasted each year through overuse of medical services. Other estimates have put the figure as high as $800 billion.
Those numbers come from a range of studies that have documented use of some procedures that are unlikely to deliver much medical benefit, are no more effective than cheaper treatments or are not desired by patients once they have been fully informed of potential side effects and complications.
Examples include yearly pap smears for women, despite scientific evidence showing that a three- or five-year interval is just as effective. Or the prescribing of antibiotics for viral illness like the common cold. Or the use of stenting for patients with stable heart disease who are not suffering a heart attack.
Dr. Elliott Fisher, director of The Dartmouth Institute at Dartmouth College in New Hampshire and an internationally known expert on medical overuse, said stents are a good example of how a valid therapy for certain patients has been expanded too much.
“Most patients will believe that having an elective stent done when they have stable chest pain is going to prevent a heart attack, but randomized clinical trials do not show that to be true,” Fisher said.
Another common overuse category is spinal surgery for nonspecific back pain that’s not connected to an infection or a disease, he explained.
“Even with something like a slipped disk, studies show that most people will get better if they try six weeks of physical therapy,” Fisher said.
Dartmouth has been a leader in analyzing how levels of health care usage can vary greatly among different regions of the country. California ranks fifth in the nation in terms of “treatment intensity,” behind New Jersey, New York, Florida and Nevada.
Studies from Darmouth and elsewhere have indicated that patients tend to receive more treatment in parts of the country with greater numbers of doctors and hospitals. This means it’s more likely for patients in these resource-rich areas to be admitted into a hospital and receive aggressive treatment, particularly in their final few years of life.
While a greater likelihood of treatment might seem like a good thing, it can be detrimental if certain therapies aren’t needed in the first place. Every surgery comes with risks of infection and medical error, not to mention the financial expense for the patient, insurance company and ultimately taxpayers in general.Even within a city, there can be high variability in the cost of medical procedures among health providers.
And disconnects between physicians and insurance companies can often result in patients paying for services that end up not being categorized as essential or coverable.
More testing.
More surgeries.
More technology.
For decades, the measuring stick for medical progress has been doing more.
But while modern medicine has regularly delivered amazing new treatments, there is growing concern that some procedures are overused.
Simmering since the late 1970s, the push for reform became very real in 2010 with passage of the Affordable Care Act. The law includes provisions aimed squarely at medical overuse, which studies have shown can harm patients and drive up health care costs.
Last week, hundreds of medical experts gathered at the Omni Hotel in downtown San Diego to discuss ways to make sure patients are getting the right amount of care when they need it — without having to undergo unnecessary procedures or missing out on early interventions that could head off bigger problems later on.
Organized by the Boston-based Lown Institute, the symposium brought together doctors, patients and their advocates from across the nation.
“The core problem, I think, is that what people want is health, not necessarily health care, but what the system incentivizes is more health care,” said Dr. Vikas Saini, the institute’s president.
The medical establishment has paid increasing attention to the topic. In 2010, the Institute of Medicine estimated that about $210 billion is wasted each year through overuse of medical services. Other estimates have put the figure as high as $800 billion.
Those numbers come from a range of studies that have documented use of some procedures that are unlikely to deliver much medical benefit, are no more effective than cheaper treatments or are not desired by patients once they have been fully informed of potential side effects and complications.
Examples include yearly pap smears for women, despite scientific evidence showing that a three- or five-year interval is just as effective. Or the prescribing of antibiotics for viral illness like the common cold. Or the use of stenting for patients with stable heart disease who are not suffering a heart attack.
Dr. Elliott Fisher, director of The Dartmouth Institute at Dartmouth College in New Hampshire and an internationally known expert on medical overuse, said stents are a good example of how a valid therapy for certain patients has been expanded too much.
“Most patients will believe that having an elective stent done when they have stable chest pain is going to prevent a heart attack, but randomized clinical trials do not show that to be true,” Fisher said.
Another common overuse category is spinal surgery for nonspecific back pain that’s not connected to an infection or a disease, he explained.
“Even with something like a slipped disk, studies show that most people will get better if they try six weeks of physical therapy,” Fisher said.
Dartmouth has been a leader in analyzing how levels of health care usage can vary greatly among different regions of the country. California ranks fifth in the nation in terms of “treatment intensity,” behind New Jersey, New York, Florida and Nevada.
Studies from Darmouth and elsewhere have indicated that patients tend to receive more treatment in parts of the country with greater numbers of doctors and hospitals. This means it’s more likely for patients in these resource-rich areas to be admitted into a hospital and receive aggressive treatment, particularly in their final few years of life.
While a greater likelihood of treatment might seem like a good thing, it can be detrimental if certain therapies aren’t needed in the first place. Every surgery comes with risks of infection and medical error, not to mention the financial expense for the patient, insurance company and ultimately taxpayers in general.Even within a city, there can be high variability in the cost of medical procedures among health providers.
And disconnects between physicians and insurance companies can often result in patients paying for services that end up not being categorized as essential or coverable.
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