New effort by MDs to cut wasteful medical spending

RICARDO ALONSO-ZALDIVAR

Asso­ci­ated Press

WASHINGTON — Old check­list for doc­tors: order that test, write that pre­scrip­tion. New check­list for doc­tors: first ask your­self if the patient really needs it.

Nine med­ical soci­eties rep­re­sent­ing nearly 375,000 physi­cians are chal­leng­ing the widely held per­cep­tion that more health care is bet­ter, releas­ing lists Wednes­day of tests and treat­ments their mem­bers should no longer auto­mat­i­cally order.

The 45 items listed include most repeat colono­scopies within 10 years of a first such test, early imag­ing for most back pain, brain scans for patients who fainted but didn’t have seizures, and antibi­otics for mild– to-moderate sinus distress.

Also on the list: heart imag­ing stress tests for patients with­out coro­nary symp­toms. And a par­tic­u­larly sober­ing rec­om­men­da­tion calls for can­cer doc­tors to stop treat­ing tumors in end-stage patients who have not responded to mul­ti­ple ther­a­pies and are inel­i­gi­ble for exper­i­men­tal treatments.

Dr. Chris­tine Cas­sel, pres­i­dent of the Amer­i­can Board of Inter­nal Med­i­cine, said the goal is to reduce waste­ful spend­ing with­out harm­ing patients. She sug­gested some may ben­e­fit by avoid­ing known risks asso­ci­ated with med­ical tests, such as expo­sure to radiation.

“We all know there is overuse and waste in the sys­tem, so let’s have the doc­tors take respon­si­bil­ity for that and look at the things that are overused,” said Cas­sel. “We’re doing this because we think we don’t need to ration health care if we get rid of waste.” Her group sets stan­dards and over­sees board cer­ti­fi­ca­tion for many med­ical specialties.

The rec­om­men­da­tions come at a time when Amer­i­can health care is under­go­ing far-reaching changes. No mat­ter what the Supreme Court decides on Pres­i­dent Barack Obama’s health over­haul, employ­ers, law­mak­ers, insur­ers and many doc­tors are ques­tion­ing how the United States spends far more on med­ical care than any other eco­nom­i­cally advanced coun­try and still pro­duces mediocre results overall.

Until now, the health care sys­tem has rewarded doc­tors for vol­ume. Now the focus is shift­ing to pay­ing for results and coor­di­na­tion. That explains the urgency for doc­tors them­selves to iden­tify areas of ques­tion­able spending.

It’s unclear how much money would be saved if doc­tors fol­lowed the 45 rec­om­men­da­tions rig­or­ously. Prob­a­bly tens of bil­lions of dol­lars, and maybe hun­dreds of bil­lions over time. That would help, but come nowhere near solv­ing, the prob­lem of high health care costs.

The nation’s med­ical bill hit $2.6 tril­lion in 2010. A major quandary for cost-cutters is that most of the spend­ing is attrib­ut­able to a rel­a­tively small share of very sick peo­ple. Just 5 per­cent of patients accounted for half the total costs among pri­vately insured peo­ple, accord­ing to a recent study from the IMS Insti­tute for Health­care Informatics.

Dr. James Fasules of the Amer­i­can Col­lege of Car­di­ol­ogy said the goal is to begin chang­ing atti­tudes among patients and doctors.

“We kind of have a gen­eral feel­ing that if you don’t get a test, you haven’t been cared for well,” said Fasules. “That has per­me­ated Amer­i­can cul­ture now.” The new advice isn’t meant to over­ride a doctor’s judg­ment, Fasules added, but to inform and sup­port decisions.

The rec­om­men­da­tions will be cir­cu­lated to con­sumers and doc­tors by a coali­tion call­ing itself Choos­ing Wisely, which includes employer groups, unions, AARP and Con­sumer Reports. Nei­ther the insur­ance indus­try nor the fed­eral gov­ern­ment was involved in process.

Each of the nine med­ical soci­eties sub­mit­ted five tests or treat­ments they viewed as overused. Their work was coor­di­nated by a foun­da­tion that’s an off­shoot of Cassel’s group. Eight other med­ical soci­eties are devel­op­ing addi­tional rec­om­men­da­tions, Cas­sel said.

The med­ical soci­eties don’t have any power of enforce­ment, and fear of mal­prac­tice law­suits may well prompt many doc­tors to keep order­ing as many tests as ever.

Insur­ers will cer­tainly take a close look at the rec­om­men­da­tions, but what they do may be lim­ited. That’s because most of the ques­tion­able tests and treat­ments in the lists don’t par­tic­u­larly stand out in the avalanche of bills processed daily by insur­ance companies.

Take a rec­om­men­da­tion for no annual EKGs for low-risk patients with no heart symp­toms. Dr. John Santa, direc­tor of the Con­sumer Reports Health Rat­ings Cen­ter, said he used to rou­tinely order EKG’s when he was a gen­eral adult med­i­cine prac­ti­tioner. EKGs cost $50 to $60. A med­ical assis­tant would do the tests, and it would take Santa just a cou­ple of min­utes to read them. Yet 2 per­cent to 3 per­cent of his income came from EKGs, enough to make a dif­fer­ence in a tight year.

“It’s very dif­fi­cult for an insur­ance com­pany to tell the dif­fer­ence when an EKG is being used as a diag­nos­tic tool and when it is being used as a screen­ing test,” said Santa. “It would prob­a­bly cause more trou­ble for insur­ance companies.”

The med­ical groups that par­tic­i­pated are: Amer­i­can Acad­emy of Allergy, Asthma & Immunol­ogy; Amer­i­can Acad­emy of Fam­ily Physi­cians, Amer­i­can Col­lege of Car­di­ol­ogy, Amer­i­can Col­lege of Physi­cians, Amer­i­can Col­lege of Radi­ol­ogy, Amer­i­can Gas­troen­tero­log­i­cal Asso­ci­a­tion, Amer­i­can Soci­ety of Clin­i­cal Oncol­ogy, Amer­i­can Soci­ety of Nephrol­ogy, and Amer­i­can Soci­ety of Nuclear Cardiology.

Posted by AP News on Apr 4 2012. You can follow any responses to this entry through the RSS Feed. Comments can be made below.