Wednesday, October 5, 2011

Saving Health Care Costs the Easy Way

How would you like to have physicians in the USA cut health care costs by more than 6 billion dollars a year in a rather simple non-painful way? A recent study in the Archives of Internal Medicine looked at rather commonly done tests and prescribed medications.

The National Physicians Alliance (NPA) initiated a project called “Promoting Good Stewardship in Clinical Practice.” They have published lists of the “top 5” activities in primary care (family medicine, internal medicine, and pediatrics) that could improve both care and the use of clinical resources. After testing showed physician support for these evidence-based, cost-saving, easy-to-implement activities, the group published their lists with simple guidelines like:

1. Don’t do imaging for low back pain within the first six weeks unless red flags are present.
2. Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.
3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.
4. Don’t use bone-density screening for osteoporosis in women under 65 or men under 70 with no risk factors.
5. Do use only generic statins when starting lipid-lowering drug therapy.

The biggest savings was by the use of generic statins, but all of these five steps were well supported by medical evidence and had peer group support.

If medicine were a large business with careful accounting and accountability, these five steps would be implemented (or the manager fired). But we have a large messy expensive system with little accountability.

Can we step up to evidence based peer supported medical practice? Otherwise I fear the cuts (which are coming) will be painful and illogical.


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