Challenging how medicine is practiced. Saving money, saving lives. Keep an open mind.

I recently posted an article entitled, Ten things you can (really) do to control health care costs. That is only part of the story. The real savings lie in how health care is provided while challenging conventional wisdom and financial incentives. An excellent article by a physician appears on The Healthcare Blog. Here is a summary of the key points. Check out the entire article.

Some of these suggestions may upset or even scare you. Most are counter to what you generally hear or have come to accept as normal practice.  However, you should approach this with an open mind. The scare tactics of the “death panels” crowd are not helpful or accurate.  It seems to me we all want the best medicine possible not just the most medicine possible.  Keep in mind that until we fix the system every part of health care in the U.S. is built around incentives to provide more services.  You won’t accept that from your auto mechanic or banker or anyone else selling you something, why accept it without question when it comes to health care?  Oh yes, some of the unnecessary care is simply CYA, another problem yet to be dealt with.

First and foremost this not just about saving billions of dollars, it is also about higher quality health care and less risk for patients.  These issues are what is most important to you.  Keep an eye on those words, comparative effectiveness as you will be hearing them often in the future. PPACA contains new funding for such studies and the potential results from those studies form the basis for cost savings in the future (we hope).  I have added the bold in the following.

So, what can we in the USA do RIGHT NOW to begin to cut health care costs?

An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big ticket items, saving vast sums while improving quality of care.

Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.

The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.

Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.

Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.

CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.

We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.

Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.

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