Newtown, CT – February 22, 2013
Ninety tests and treatments out of thousands doesn't seem like a lot, but it is – And that's because, building on their important (albeit modest) initial work, the ABIM Foundation has gathered support from additional medical specialty societies to call out overused treatments that harm patients and contribute to the billions in excess spending in the US. The new list, released yesterday, has the additional merit of being clear and unambiguous. It starts with an issue that we've raised before and that Leah Binder eloquently hammers in her Forbes blog: elective inductions and c-sections before full term. These harm moms and babies alike. The list also includes a strong recommendation to avoid doing stress tests using echocardiographic images to assess cardiovascular risk in persons who have no symptoms and a low risk of having coronary disease. These lead to unnecessary interventions such as PCIs. There are also other tests and interventions that are highlighted and noteworthy on the new list, most of which are also common sense, and have been advanced in the past by health care services researchers. The difference this time, is that it's the leadership in medicine that is finally stepping up the tempo and calling out areas of abuse. We welcome them, and encourage them not to stop with this list.
What this means to you – First, we must recognize that all of these tests and treatments have been, and continue to be paid, sometimes very generously, by private and public sector payers. As such, all payers have encouraged these bad behaviors and must stop. When a medical society says: "don't do x", why are Medicare, Medicaid, and private sector plans continuing to pay for x? If private plans simply stopped paying for elective inductions and c-sections before full term, the practice would stop overnight. If Medicare and private sector plans stopped paying for stress tests on asymptomatic patients, those would stop as well. So the real question we should all ask now is when will the payers do their part? Second, we must also recognize that Board-certified physicians who perform these early elective inductions, unnecessary stress test, CT scans, intubations, and EEGs have been Board-certified, and re-certified. While the medical societies are recommending that physicians don't perform certain tests, there are no implications to their professional standing if they do. Why not? So the real question we should all ask now is when will the Boards finally take their responsibility seriously and strip the certifications from those who fail to practice in a manner that reflects a reasonable bar of competence? Because make no mistake about any of this. It's fine to put out a list, and to publicize it, but when you're pregnant and anxious, or feeling out of sorts and uncertain, what your doctor says and recommends is usually what you, as a patient, will do (unless it involves shelling out a lot of personal cash). So real change won't happen as a result of this list unless it is converted into payment policy and professional standards. We will be watching and keeping score.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.