Jul 7 2009, 9:02AM
Medical Tests: "Does it work?" matters less than "Does it pay?"
In a previous post I had worried that "Comparative Effectiveness Research" was going to be the sexy new buzz word, the one a fresh generation of physicians (particularly in academia) would adopt in just the way a previous generation made "EBM" (Evidence Based Medicine) their mantra. Well, I think I am coming around.
When President Obama speaks about funding health reform, he keeps emphasizing that the money needed to achieve his goals of covering the uninsured, is already in the system:
"Two thirds of the cost would be covered by re-allocating dollars that are already in the health care system, taxpayers are already paying for it, but it's not going to stuff that's making you healthier." (From his appearance on ABC's Prescription for America).
I recently came across a great resource (thanks A.J.!), the California Technology Assessment Forum whose goal is to assess new and emerging technology. It is edifying to look at the list of tests it has assessed, pages of them, and to see how few meet its criteria for a test that improves health outcomes and is safe and effective. And yet the tests are being done and we are collectively paying for them.
Hats off to the President for taking on health care reform, because if you read the CTAF's list of tests that are ineffective, you are also looking at a list of device manufacturers and others who are doing very well on these procedures and tests--every one of them is going to battle him tooth and nail, primarily through their lobbyists in Congress. I sense the President is doing the right thing by taking the message to the public, to us, counting on our sense of outrage to say it is enough.
One of my former students, a brilliant physician who has gone into a rural practice where he does it all--delivers babies, takes care of children, adults, performs procedures--wrote the following to me (tongue in cheek) and I have his permission to use it:
"I justify ordering expensive and unnecessary tests in the following way: It is clear that the current health system is unsustainable. The sooner it collapses, the sooner we can start over again, hopefully with something better. I intend to do my part to bring the system to its knees as soon as possible. (That's only funny because I'm not that way.)"
It's only funny because he truly isn't that way.
Comments (2)
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Abraham Verghese
Little of this is new information.
Note that the CTA judgments are as of the time a request was submitted and review completed. These are their criteria:
1.The technology must have final approval from the appropriate government regulatory bodies.
2.The scientific evidence must permit conclusions concerning the effectiveness of the technology regarding health outcomes.
I reviewed the cardiovascular procedures.
One of the things our office has recently started doing, a year or so ago (that I'm somewhat skeptical about), was last reviewed by the CTA Board in 2003, when the evidence wasn't yet in, at least to their standard.
That doesn't mean it isn't in now; I still just don't know. I presume so, or MediCal wouldn't be paying for it, and they are actually one of the more reliable payors.
Just a caveat, but thanks for the pointer.