Walking a fine line

If it feels like you are being pulled in multiple directions lately, it’s because you probably are.

Healthcare professionals face many conflicting interests in the current climate of reform. Practices must serve their patients, but also protect their own interests as well, which can be a challenge.

Case in point: breast cancer screening guidelines. Four respected organizations have issued guidelines that differ slightly, presenting a tough decision for physicians, as described this week in JAMA. The American College of Radiology (ACR) and American Cancer Society recommend annual screening mammography for women aged 40 and older, while the U.S. Preventive Services Task Force recommends biennial screening mammography, and only after age 50. Meanwhile, the American College of Obstetricians and Gynecologists lands somewhere in the middle by suggesting to offer annual mammography, but stating that biennial exams may be “more appropriate” for some women.

What do you do if you subscribe to the belief that biennial screening is more appropriate, but are worried about the risk of malpractice should you discourage annual screening? Allen Kachalia, MD, JD, and Michelle M. Mello, JD, PhD, both of Harvard School of Public Health in Boston, tempered some of these fears by noting that guidelines are not intended to establish legal standards, and clinicians can protect themselves by educating patients on conflicting guidelines and documenting the rationale for recommendations.

News regarding the stalled launch of the Independent Payment Advisory Board (IPAB) this week provided another example of the complex situation in healthcare. The board is at the center of the Accountable Care Act, but was also the cause of much wailing and gnashing of teeth because its cost saving recommendations would get added legislative weight. All the chatter may have been much ado about nothing, as current Medicare spending levels aren’t currently projected to rise to the levels that would trigger the IPAB into action.

Even discussing issues of healthcare costs represents a fine line to walk, as evidenced by a New York Times article this week on the cost of healthcare in the U.S. The article used colonoscopies as a case study, and while it made some excellent points about conflicts of interest and unnecessary care, colorectal cancer screening remains a key lifesaving tool. The ACR quickly issued a statement urging people not to forgo recommended screening based on concerns raised in the article.

What fine lines are you or your practice walking lately?

Evan Godt, Sr. Staff Writer