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Tuesday, January 14, 2014

Getting the Right Care at the Right Time: Why Consumers Should Care About Health System Transformation

Kim Bailey

Health System Improvement Program Director

Consumers rely on doctors to employ best practices in the delivery of health care. Whether it’s offering advice on which preventive screenings are necessary or diagnosing a life-threatening illness, we trust that our physicians base the way they deliver care on evidence.

That’s why many are surprised to learn that medicine is more an art than a science. As one frequently cited study published in the New England Journal of Medicine found, evidenced-based care is delivered only half of the time.

Because the existing evidence on how to treat many conditions is limited, providers often use their best guess or personal preference, rather than solid science, to determine which treatment options to recommend. As a result, there is wide variation in the care that providers deliver.

How does a lack of evidence-based medical treatment affect consumers?

Differences in care delivery come at a cost that goes beyond the financial. Patients can actually suffer negative consequences when doctors deliver too much care, too little care, or the wrong care.

For example, studies show wide variation in the number of CT scans ordered from physician to physician. In the same practice, one doctor might order twice as many CT scans as his or her partner. If you happen to go to a doctor who refers more patients to get scans, you could face higher health care costs and exposure to radiation.

Each CT scan that subjects patients to between 150 and 1,100 times the radiation of an x-ray raises concern about the link between exposure to radiation and cancer.

CT scans are a powerful diagnostic tool when used correctly, but they become potentially harmful and expensive when used to excess.

Is the care that our doctors recommend for us truly necessary?

The health care industry has seen many examples similar to the overuse of CT scans. These include differences in the use of coronary stents, different patterns in prescribing drugs, and the length of hospital stays. Not only does this variation in treatment translate to varying health care costs for people with the same medical condition, but it also means that many people aren’t getting the right care, which is not a good use of either the consumer’s or physician’s time.

For example, a study featured in the New York Times a couple weeks ago concluded that one of the most common types of orthopedic surgery—repairs to torn meniscus to help stabilize knees—worked no better than fake operations, which suggests that thousands of people may be receiving unnecessary surgery. Doctors perform meniscus repairs 700,000 times a year at a cost of about $4 billion. Experts now believe this procedure should be targeted to a narrower group of patients.

How do we improve the health system to ensure that consumers receive the right care?

As health care consumers, we must demand quality, evidence-based care. We have to engage in conversations with our providers about what treatments meet our individual needs.

And we must insist that the health system changes so that providers are rewarded for delivering the best care rather than more care.