The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.
Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine at the Stanford University School of Medicine highlighted seven often unnecessary things done in primary care, such as EKGs in patients without symptoms, that were identified by the Good Stewardship group convened by the National Physicians Alliance.
Later, Dr. Steve Weinberger, Executive Vice President and CEO of the American College of Physicians identified sensible principles to guide the integration of a “less is more” theme in public policy, such as:
- Avoid interventions that don’t help and may harm
- Give incentives to physicians and patients to avoid low value care
- Use payment approaches that are politically feasible, medically appropriate and minimally burdensome
- Recognize that there will always be exceptions.
The discussion addressed the tip of the iceberg. The next step is to move to the big-ticket items where the literature is quite clear that patients are harmed by back surgeries for which there is no evidence of efficacy, cardiac bypass surgeries that are unwarranted, and duplicative and unnecessary diagnostic imaging that exposes patients to cancer-causing radiation, among many other tests and procedures performed that may cause more harm than good.
We can’t put all of the health care reform burden on patients, even with shared decision-making. Physician leadership is essential. That’s why this meeting will hopefully be the first of many conversations on K Street and on Capitol Hill.
In the end, this is all about good care of the patient. That’s the primary motivation. It’s also true that as a society, we don’t have money to waste. As I wrote in The Treatment Trap, the best way to preserve Medicare is to pay for things that improve health and well-being, and to stop paying for things that don’t. If we don’t get it right, and get it right soon, even the good things will be cut. Let’s act on the wisdom we have that knows the difference.
Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation. She is author of The Treatment Trap and Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans. This article originally appeared on The Medical Professionalism Blog.
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