Quit Wasting My Healthcare

Silver Bullet for Lower Healthcare Costs

I write that title somewhat facetiously.  Of course there is no silver bullet to reduce health care costs and improve quality–or in other words, increase healthcare value.  But there is one thing that is as close to a silver bullet as I can think of:

Bring value to the exam room decision making process between physician and patient.

That’s where the rubber hits the road.  Currently, that decision making process is largely low value.  What do I mean low value?  (1) It does not bring to bear current clinical best practices and (2) it does not attempt to be cost-effective without compromising care. 

Here is an example of (1)–a June 2003 study from the New England Journal of Medicine (http://content.nejm.org/content/vol348/issue26/) found that physicians only followed their OWN best practices 50% of the time.  That means, roughly, 50% of the time patients are getting short changed.  Now sure, sometimes best practices should not be applied to a particular situation–drug interaction, adverse reaction to medication, etc–but I am sure that is not true 50% of the time.

Here is an example of (2)–MRI’s of the lumbar spine are frequently ordered for patients with acute low back pain, but who don’t have any “red flag symptoms” of spinal cord compromise.  According to the American Academy of Family Practice, that MRI can wait 4 – 6 weeks, during which time the pain usually resolves and if it does, then the MRI is not necessary (http://www.aafp.org/afp/20070415/1181.html).  Waiting on that MRI will save $2,500, but that number hardly ever enters into the decision making process.

So, HOW does one bring value to the exam room decision making process?  That is the million (or more like billion) dollar question.  Some say “Value-Based Benefit Design.”  Others say create ”Medical Homes.”  Still others say ”Healthcare Consumerism.”  The answer is that it is probably some combination of those three and probably something else that hasn’t been thought of yet.  (As a physician, I can tell you of DOZENS of ways to improve clinical practice and be more cost effective and I have some more specific ideas on the HOW, but I will save that for another entry.)  But, at the end of the day, any strategy that focuses on bringing value to the exam room decision making process is at least moving us in the right direction.