Happy holidays! It’s difficult to believe that another year is ending already. What can we say about 2011? It was a year in which the media, healthcare experts, and the government seemed to constantly debate whether it is possible to improve the quality of healthcare in the United States while reducing escalating healthcare costs at the same time.
In many ways, 2011 was no different from preceding years. New drugs, biologics, and devices were approved by the Food and Drug Administration; others were recalled for safety reasons or lack of efficacy. Likewise, new operative procedures were implemented, including transcatheter aortic valve implantation (TAVI), which delivers various aortic valves via a catheter rather than in an open procedure.
From my perspective, what made 2011 different, however, was the emphasis on evidence and the growing awareness that implementation of evidence-based processes is one way to reduce the volume of unnecessary procedures that drives up costs without improving patient care. Of significance was research published in the Archives of Internal Medicine that reported that unnecessary treatments and diagnostic screenings drove up medical costs by a whopping $6.8 billion in 2009. And the lead author considered that a conservative estimate! The researchers found that healthcare providers often ordered blood and other diagnostic tests even when they were not indicated, citing physician training, defensive medicine, and patient expectations as the reason.
The National Physicians Alliance (NPA) advocated the need for evidence-based care with its project, “Promoting Good Stewardship in Clinical Practice,” which attempted to identify unnecessary or harmful treatments in family medicine, internal medicine, and pediatrics. This project was the outgrowth of a request from Dr. Howard Brody, Director of the Institute for Medical Humanities at the University of Texas Medical Branch at Galveston, who asked that physicians identify:
“five diagnostic tests or treatments that are very commonly ordered by members of that specialty, that are among the most expensive services provided, and that have been shown by the currently available evidence not to provide any meaningful benefit to at least some major categories of patients for whom they are commonly ordered.”
Using comparative-effectiveness research, the NPA working groups created “Top Five Lists” in these three specialty areas that provided physician guidance for how to eliminate unnecessary testing and treatment while continuing to provide patients with high-quality healthcare. For example, the group advises providers not to order blood chemistry panels (e.g., CMP, SMA-7, BMP) or urinalyses for screening in asymptomatic, healthy adults. Other recommendations include using generic statins when initiating lipid-lowering drug therapy, and eliminating annual electrocardiograms or any other cardiac screening for asymptomatic, low-risk patients. You can access these lists here.
Evidence was a term we heard over and over in 2011 and we’ll continue to hear it even more in 2012, as new policies and regulations loom and decisions are made with regard to the constitutionality of the Patient Protection and Affordable Care Act (PPACA). The value of evidence as it relates to the provision of healthcare has entered our consciousness and it will not go away. In the coming year, Hayes will continue to evaluate new evidence as it becomes available and make recommendations for our clients. We’ll also keep you apprised of efforts by advocacy groups to implement evidence-based processes that will improve patient outcomes. In the meantime, we wish you a joyous holiday season and a new year of prosperity and good health ahead.