That’s defined as care that does not improve patient outcomes, and it was the subject of Dr Rick Victor’s concluding remarks at the WCI conference. And the answer is, well, let’s consider the data first.
First, who cares? Not my problem, right? Consider that other research indicates the average household is working 4 weeks just to pay for the estimated total amount of dollars spent on unnecessary care.
When you put it in that perspective, it becomes very, very real. Dr Victor went on to discuss various indicators of wide variations in medical practices in comp. For example, docs inassachusetts are ten times more likely to prescribe schedule ll narcotics when prescribing narcotics than physicians in texas.
If you are prescribed narcotics in Louisiana you are four times more likely to become a long-term user of narcotics than in the lowest ranked state.
If you have a disc problem, you are almost three times more likely to get back surgery if you are in Tennessee than if you live in California.
Why?
Well, perhaps there are financial motivations at play. Victor reported their research indicates surgeons that own a surgery center do 76 more surgeries each year than non-owners.
And yes financial ownership is a driver, but owned ASCs are more efficient so they can do more, and owners were usually operating more often before they became owners.
But with all that, there are still 20% more surgeries done by docs who own ASCs when you account for these confounding factors.
Are they unnecessary? Well, Medicaid patients weren’t getting more surgeries, work comp patients were. And by the way, the same 20% increase was seen in colonoscopies.
And that’s not even getting into the huge differences in prescribing patterns exhibited by docs who begin to dispense drugs out of their own offices.
What does this mean for you?
Returning to the headline question, I’d suggest there is ample evidence that suggests there is indeed a lot of unnecessary medical care.
And every year you work until January 29 just to pay for that unnecessary care.
Aug
22
Hi Joe,
With respect to the surgeries, does the data account for the types of surgeries and working populations? Surgeries performed in outpatient (ASCs) are inherently different from hospital in-patient surgeries. Also, if the study is comparing Medicaid and workers’ compensation did they account for the percentage of the Medicaid population under the age of 18 (approximately 30% nationally). Another thing to consider when comparing Medicaid to other coverage is members’ role in and out of eligibility depending on financial factors. I am all for reducing unnecessary medical care; however, this information would tell us more if they compared the surgeries performed to EBM and clinical outcomes.
Denise – thanks for the note.
The ASC data looks at total surgeries done on an outpatient basis as reported to Florida’s AHCA.
While I agree the data would be even more helpful if it included comparison to EBM, that was beyond the scope of the study and those data were not available from the source.
net is the analysis looks to be useful indeed as it includes a standardized dataset over a time period that includes new ownership of facilities by surgeons.
Hi Joe,
Interesting subject/post. What organization does Dr. Victor represent and is there a link to the research he discussed?
Also I think you “in Massachusetts” when you wrote “inassachusetts.”
Keep up the great work,
R.J.
As an orthopedic surgeon I have long been amused at the orthopedic community’s response to one of the few controlled clinical studies in our field. The Moseley study on knee arthroscopy, which included doing sham surgery on the control group, created immense controversy. It showed that arthroscoping arthritic knees was not very useful as patients had no sustained relief of symptoms. This had an economic impact on many surgeons, with some loudly defending and continuing to perform a procedure shown to have no benefit. The protests were loud and long because it hit surgeons in the wallet. I still see this done in the workers comp population despite it being of no sustained benefit. I could go on with other examples.
You need go no further than the Dartmouth Atlas to view the geographic utilization variations in Medicare for the past several decades. There is plenty of unnecessary care to go ’round.
Medicare patients often are not trying to get back to work before they lose their jobs, that might account for some of the difference in the numbers. Sitting out on welfare or other benefits where you don’t have to use your body like someone who works does, probably is a disincentive to trying a surgery that may not work.