Wednesday, March 31, 2010

Will Healthcare Reform Help Curb Unnecessary Care?

The New York Times just published an article stating that many doctors feel the new bill will do little to curb the use of unnecessary testing. Patient demand and fear of litigation will continue to fuel the overuse of tests and treatments unless something happens to counteract this. Doctors make a legitimate point; "If a patient comes in demanding an MRI, there is no incentive for me to say no even if I know it is not needed". To reduce this there will have to be a change in the way patients think about healthcare, how medicine is practiced and how it is paid for.

Setting up guidelines is not the answer. A good example of this failure is CT scans. Clear guidelines for when CT is needed have been in place for years. They say among other things that CT is not indicated after most car accidents. Many patients have no real risk of brain injury after an accident, but try telling that to the injury lawyers. These guidelines have not put a dent in overuse of CTs in these situations. Again there are no incentives in place to withhold the test, only liability.

These doctors feel that there is nothing in the new law that will address this issue head on, but that conclusion may be a little hasty. The law includes pilot programs to pay doctors more for delivering better care at a lower cost. The key here is better care not less care. Eliminating the unnecessary CT is a good thing. Eliminating the necessary CT because of financial incentives to do so is a problem. But any well intentioned efforts to reduce waste will certainly be quickly labeled as rationing care. As Uwe E. Reinhardt, a well known health economist in Princeton, stated,"The minute you attack overutilization you will be called a Nazi before the day is out".

We need to get past this and support efforts to promote efficient care and reduce unnecessary tests. One section of the new bill establishes a private, nonprofit organization called the Patient-Centered Outcomes Research Institute to address this head on. They will have a $10 million budget this year which will grow significantly in coming years. The intent is to ground physician decision making in science and limit the influence of outside factors such as marketing and litigation.

This won't erradicate overutilization, but its a start.

More on this later.

Mark Brodeur

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