Whether it's low-value or no-value care, America dispenses way too much of it, according to prominent surgeon and journalist Atul Gawande, M.D., although he sees a silver lining ahead.
Gawande, in the most recent issue of the New Yorker magazine, concluded that America is overrun by an epidemic of care that contributes little to the overall health of patients. This care includes performing an electrocardiogram for patients complaining of headaches; ordering CT or MRI scans for lower back pain without any other indications of a neurological problems; or placing coronary stents in patients with heart disease that's been stabilized.
"Millions of people are receiving drugs that aren't helping them, operations that aren't going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm," Gawande writes. He noted that the phenomenon has had an impact on virtually every American household, taking thousands of their dollars in out-of-pocket costs and leading to "reduced spending on food, clothing, education and shelter."
Gawande discussed his mother having a cardiac catheterization after a fainting spell tied to dehydration. A family friend's father who suffered fainting spells underwent a triple bypass in his 80s, even though it did not address his condition. He suffered a stroke during the operation. Elsewhere, simple cataract surgeries are complicated by extensive and unnecessary pre-surgical tests.
Gawande has made suggestions in the past about fixing healthcare delivery in the United States. Three years ago, he said that large hospitals should try to operate like big restaurant chains such as the Cheesecake Factory in order to become more efficient.
However, Gawande noted that the Affordable Care Act has had a calming effect on unnecessary care. McAllen, Texas--which Gawande profiled six years ago as having more money spent on Medicare beneficiaries than in any other part of the country--has cut its spending dramatically since the passage of the healthcare reform law. Local providers formed an accountable care organization and collaborated on cutting unnecessary care.
However, other healthcare industry observers say that accountable care organizations are too bureaucratic and do not provide enough financial incentives to function properly, according to Forbes.