January 15th, 2013 - Nearly half of the physicians in our country think we are delivering too much care. In a recent survey conducted by the Dartmouth Institute for Health Policy and Clinical Practice, in association with Dr. Brenda Sirovich from the Outcomes Group at a Veterans Medical Center, 627 physicians from an American Medical Association database were asked to share their thoughts. More than 40 percent thought their own patients received too much care, six percent thought too little care, and the remaining thought just the right amount of care. (http://archinte.jamanetwork.com/article.aspx?articleid=1105947&link=xref
“Physicians seem to realize that there are excesses of the medical care system,” Dr. Sirovich pointed out in a recent article in the National Journal
. “Almost half saw it in their own practices—their own patients are getting what they describe as too much care.” Most importantly, Dr. Sirovich reflected, “We found that primary care physicians see there’s a problem with the excesses of the healthcare system, and successful reform would be much harder if physicians didn’t see that and weren’t engaged in the solution.”
Many physicians believe two of the major reasons for excess care are: (1) the “fee for service” system which has been our traditional system of paying a fee for each health service rendered, and (2) the medical malpractice system.
We have all heard the United States spends too much on healthcare. This statement is not a partisan point of view but rather a fact based on our nation’s current inability to fund Medicare, Medicaid, Social Security, Armed Services and pay our interest expense (the cost of our borrowing). If our healthcare system were a nation, it would be the fifth largest economy in the world.
In America, we spend an average of $8,000 per person per year on healthcare but the range
of spending, however, is huge. For instance, Miami/Dade spends twice that amount whereas Collier County’s spending is slightly less than the national average. More often than not, less
spending leads to better outcomes. The “fee for service” system will probably evolve into a global payment system with rewards for quality, efficiency, and volume—all in equal proportions.
A 2004 study in Health Affairs
found there is actually worse care in states with higher Medicare spending. Another study, reported in the Annals of Internal Medicine
in 2003, showed that Medicare patients who lived in areas with higher healthcare spending did not get better results. Both of these articles were reviewed in an overview focused on the cost of healthcare in our country, compared to the globally competitive world in which we now live.
Malpractice reform would help decrease defensive medicine which causes unnecessary testing. Excessive testing can lead down a path involving a diagnostic cascade of even more testing, followed by potentially unnecessary treatment. Being prudent, sticking to evidenced-based medicine and understanding the risks and rewards of care will make a significant difference in the overall outcome.
As medicine evolves from the analog handwritten note to the digital computer-based medical record, we will be better able to assess the value of care rendered. Aggregating data into information and, in turn, knowledge was very difficult without digital medical records. Population health metrics, measurements of the overall health of a group of people in an area, collected manually in the past was tedious and fraught with errors. Digital collection is not perfect for sure but is so much more efficient, accurate, and scalable. Namely, by using the same measures for many people we can quickly find out whether a new test or treatment is better than the existing ones.
This new era of digital technology will help everyone understand how best to practice evidence-based medicine, what is overdone, and what is missing. All together we will help avoid the harm of overtreatment.