Curb Unnecessary Surgeries; Change the Incentives
|October 25, 2013||Posted by Staff under Editorials|
by USA Today Editorial Board, 2013 on July 7
Patients continue to be wheeled into operating rooms tens of thousands of times a year for operations they simply don’t need. Whether it’s cardiac stents, knee replacements, hysterectomies, or dozens more procedures, too often there is no medical reason to do them and a simpler, less invasive way to treat the problem.
At worst, such surgeries can kill or disable patients, or leave them in chronic pain. An unnecessary pacemaker cost Jonathan Stelly, one of the people featured in USA TODAY’s report, his baseball career. Even when unneeded operations go well, they cost money that patients and insurers don’t need to spend, further stressing a health care system that’s already riddled with waste and costs too much.
The most notorious unneeded surgeries are done by physicians who are so greedy, incompetent, or crooked that they shouldn’t have a medical license. State medical boards can be lax about cracking down on them, and this should change.
More pervasive are the unnecessary surgeries (and tests and other procedures) that occur every year. This fee-for-service model rewards volume rather than outcomes. The more procedures that physicians, hospitals and other providers perform, the more money they make.
There are effective fixes. Some health care organizations — the Mayo Clinic, the Cleveland Clinic, Kaiser Permanente, and the Veterans Administration, for example — pay doctors salaries, which can eliminate the incentive to do more than necessary for a patient.
The same is true for accountable care organizations (ACOs in medical jargon) and “patient centered medical homes,” where providers can be paid a flat rate for a group of patients and judged by how well their patients do. ObamaCare includes provisions designed to make new models like these more common.
One of the most effective ways to cut down on unnecessary operations is for doctors to share the decision-making with their patients by pointing out alternatives and encouraging second opinions.