June 16, 2015

The “Less Is More” Medical Campaign – Part 5

What the writers say in this segment is true, but – yes, there can always be one of these – why does high-value care always need to be high-cost care.

Delivering high-value healthcare in the U.S. will require increasing the availability and affordability of needed care and decreasing waste and unnecessary care, much of which is harmful. But there are considerable barriers to reducing unnecessary and potentially harmful care.

One of the many barriers to care that quality care is the perception that more care is better medicine. The United States Preventive Services Task Force (USPSTF) recommendation in 2009 advising that mammography posed more harms than benefits for women between the ages of 40 to 50 and this was not well received nor understood as it was intended. Was the message well stated? No. The USPSTF did not emphasize that screening these women leads to net harms.

It is true that less healthcare creates fears of rationing, but that is a topic for another blog and I have written about this in the past as well. Withholding care simply to save money sometimes seems irrational. Currently many doctors and hospitals earn more money when they do more and this is a common tactic of many hospitals in addition to overcharging the system.

Many physicians and lay persons have written to thank MedPage Today for talking about this important issue and for encouraging more research into the harms of tests, procedures, and treatments. This last part of encouraging more research into the harms of tests, procedures, and treatments needs more emphasis and is seldom seen in the mainstream media, to say nothing about medical newsletters and journals – even MedPage Today seldom says enough.

Unfortunately, awareness of the harms of overuse of medical care probably isn't enough to achieve the "less is more" goal. According to the article authors, “We are very encouraged to see that many new efforts are underway to reduce overuse, including educational initiatives, computer-based alerts, and decision support tools, peer review and feedback, and system changes supported by implementation and behavioral sciences.”

Important changes are occurring in the U.S. healthcare system, moving away from fee-for-service medicine, which rewards high-volume care regardless of appropriateness, towards bundled payments, accountable care organizations, and capitated systems that can better align incentives towards high-value care. I do need to wonder if all the changes are for the better and if rationing will become too common place to the harm of patients.

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