Tuesday, March 20, 2012
The biggest challenge for fixing American health care isn't finding more money. It's learning not to spend money on the wrong things. The solution, conservatives say, is simple: Have patients bear more of the costs now being covered by private or government insurers. The concept has merit, except for this: How on earth can we mortals know we don't need something when the god wearing the stethoscope says we do?
Guidelines are needed, and this is a job for government working with medical experts. To advance the process, here are examples of some low-hanging fruit of waste, ripped from the news:
- Obesity surgery for teenagers. The New York Times reported on a 17-year-old -- 5 feet tall and 271 pounds -- who could have lost her excess weight through diet and exercise but didn't try very hard. So a New York state program for low-income people paid $21,369 for an operation whereby a surgeon placed a silicon band around her stomach to curb feelings of hunger.
After losing only 34 pounds, the girl began again downing chips and chocolate with abandon. She was almost back to where she started.
Psychological factors often underlie serious weight problems. Until obese young people -- who have time on their side -- deal with the emotional part, subjecting them to surgery is cruel and a crying waste of money.
-- MRIs for athletes with minor pains. MRIs can detect tumors and help doctors confirm their suspicions. But they also find "problems" that, while best ignored, nonetheless provide a pretext for expensive medical intervention.
As an experiment, Dr. James Andrews, a sports medicine orthopedist in Gulf Breeze, Fla., did MRI scans on 31 fit and happy professional baseball pitchers. He found abnormal shoulder cartilage in 90 percent of the athletes. Based on the scans, he could have operated on nine out of 10 of them -- totally unnecessarily.
nsurers pay over $1,000 for an MRI scan. The operation to fix the insignificant problems highlighted costs a lot more.
-- Regular bone density tests for all women over 65. By the time women hit age 65, bone loss leading to osteoporosis progresses very slowly. If their bone density is found to be normal for their age, they don't need bone density tests every two years, which Medicare covers, according to The New England Journal of Medicine.
And when all this testing finds only mildly lower bone densities, the women are often overprescribed bisphosphonates, such as Fosamax. Bisphosphonates can cause rare but gruesome side effects. They make far more sense for older women with osteoporosis.
-- Stents for patients with stable heart pain. Patients showing symptoms of a heart attack often undergo angioplasty, involving the insertion of a metal tube called a stent. But about one in eight angioplasties are done on patients with stable angina who are showing only minor chest pain, according to an article in The Journal of the American Medical Association.
For these patients, another study showed, stents didn't do any more good than oral medications -- and the operations themselves pose some risk. One doctor in Maryland reportedly extracted $3.8 million from Medicare for implanting nearly 600 medically unnecessary stents.
I almost forgot to mention double CT scans, whereby hospitals administer two computerized tomography scans to a patient in the course of a single day. CT scans are both expensive and expose patients to high levels of radiation. Medicare pays whatever. A hospital in Tulsa, Okla., was found to have double-scanned 80 percent of its Medicare chest patients in 2008.
Note that the above examples involved not only wasted money but subjected patients to potentially harmful "treatments." Want to curb medical spending? We've hardly scratched the surface.
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