Patient care: Too much or too little?

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Kaitlyn Dmyterko, staff writer

While procedures have become more precise and cardiovascular outcomes have improved, we still see cases of stenting and imaging overuse as well as cases of diagnostic procedures being underutilized. These instances force the question—how much care is too much or too little?

An interesting survey this week published in the Archives of Internal Medicine pondered whether U.S. patients receive too much care. In the survey, which included views from U.S. primary care physicians, 42 percent said that they believed patients in their own practice received too much medical care. Only 6 percent relayed that they believed their patients received too little care. Nearly 30 percent of these physicians admitted that they were practicing medicine more aggressively than they would like to.

What does this say about the varying practice styles within the medical field? During the survey, nearly 80 percent of respondents said that fear of malpractice led to their over-aggressive practice style. Should tort reform be introduced be rectify this trend?

While the survey showed that most think patients receive too much care, another study published this week in Archives found the opposite. Study authors from Brigham and Women’s Hospital suggested that more frequent office visits for diabetics could help control glucose and cholesterol levels. Morrison et al reported that diabetic patients who visited their PCP every two weeks rather than every three to six months had better outcomes. While this more frequent system would be beneficial, how would it affect the already cost-laden healthcare system?

To combat those heavy expenses, Steven E. Weinberger, MD, of the American College of Physicians in Philadelphia, suggested that performing cost-conscious care could save a whopping $700 billion in healthcare spending. He noted that reducing unnecessary imaging studies could help cut this waste. Weinberger said that chest CT scans are overused, as are CT angiograms.

The current fee-for-service model has led physicians to believe that performing more procedures, testing, etc., gains more payments. The system rewards volume, not value. These goals must be realigned to incentivize physicians for the outcome of the procedure, rather than how many times it is performed. While the culture is changing due to patients becoming older and sicker, the system must be realigned to cut waste and enhance outcomes.

On these topics or others, please feel free to contact me.

Kaitlyn Dmyterko
Cardiovascular Business, senior writer