It is no secret that there is a lot of waste in healthcare. Even if one leaves aside the most egregious examples such as duplication of tests and patient harm that necessitates more care, we still collectively do a lot of stuff that does not improve health. A recent report in Health Affairs changed my assumptions about what that stuff looks like.
The authors analyzed claims data from an all payer database in Virginia for services provided in 2014. They prospectively defined 44 services that were of “low value” defined as providing no net health benefit in specific clinical circumstances. Their assessments were based on nationally recognized standards, including the “Choose Wisely” campaign of the ABIM, the US Preventive Services Task Force, CMS criteria, and others. They then scoured the database to see how frequently these services were provided, and calculated the aggregate costs associated with them.
Continue reading Looking in the Wrong Place?
Here are a few things that have happened since Ebola arrived in the United States:
- CNN and other cable news outlets seem to have become “all Ebola all the time” with breathless reports about the latest twists and turns
- A grade school banned a teacher from the classroom because she had visited Dallas
- A photojournalist who had travelled to the affected area (and was well) was denied the opportunity to give a talk to a University audience
Parents in Mississippi kept their children home from school because the principal had visited Zambia
People all across the country seem to be in a growing frenzy about the virus. On one hand, I get it. The disease is awful, the CDC seems to have fumbled in its management of the situation and in its messaging, and the disease rages on in a few countries in West Africa. On the other hand, a lot of this is just, well, nuts.
Continue reading Keep Calm and Carry On
A recent article in Health Affairs by Thomas Bodenheimer and Mark Smith (Health Affairs, November 2013; 32:11, 1881-1886) addressed a timely and important issue: assessing the needed size of the primary care physician workforce. I found the article particularly relevant, since our medical group is grappling with this question right now, and it challenged me to think about the question differently. Continue reading Counting Doctors or Making Doctors Count
Few things unite physicians as much as the belief that the current malpractice tort system is seriously broken. The litany of complaints is long and familiar: many suits are without merit; the cost of malpractice defense forces settlements even when the “medicine” was good if the outcome was bad; lawyers take too big a slice of the financial pie; we are all forced to practice defensively to avoid getting sued, thereby driving up the cost of health care. Of all of these, the belief that malpractice fear drives physicians to overtest and overtreat seems nearly universally held. Even so, there has been very little evidence to support it, and efforts to quantify the impact of “defensive medicine” on health care costs have been largely speculative. Continue reading Fear of Malpractice Claims and Defensive Medicine