By David Ferguson
A significant amount of the healthcare administered each year to patients in the U.S. is unnecessary, expensive and ends up doing more harm than good., says Robert Pearl, M.D., in an essay for Forbes.
Pearl, CEO of The Permanente Medical Group, outlines four ways to reduce unnecessary patient care, ultimately saving families and providers money, and also empowering patients by giving them options in their care plans.
Due to the country's pay-for-services care model, Pearl says physicians have a "perverse incentive" to provide the most aggressive, expensive care possible, even in situations where a "wait-and-see" approach or less invasive care plan would work better.
For example, he notes that a 2011 study published in the Journal of the American Medical Association found that up to 22.5 percent of cardiac pacemakers are installed unnecessarily. Moreover, thousands of patients take surgical approaches to lower back pain every year, having lumbar fusions and disc removals in spite of little evidence that these procedures actually work.
Pearl writes that healthcare providers often "harm the dying" by imposing aggressive lifesaving measures when palliative care would be more appropriate. Chemotherapy and dialysis treatments often make very ill patients sicker in their final days--yet clinicians order them even when the invasive treatments are doomed to fail.
He says the industry could reduce unnecessary patient care by taking four actions:
1. Empower patient decision-making. Give patients a realistic idea of how likely a procedure or medication will work and also discuss how likely they would suffer complications.
2. Shift to value-based pay practices. This would eliminate the incentive for doctors to choose the approach that will make them the most money, rather than the approach that is best for patients.
3. Determine when new approaches are really better. Everyone wants to try the newest procedure they've heard about or the drug they saw advertised on TV, but in many cases more conservative measures are in order. A new treatment doesn't necessarily mean it's better, Pearl says.
4. Reform medical malpractice. Many physicians will do too much for patients for fear of missing an extremely unlikely problem or being sued, according to Pearl. "Making malpractice litigation and awards more rational would be better for the healthcare system in general and patients in particular," he says.
To learn more:
- read Pearl's column