Managed Care

 

At Last, Providers Are Acting To Reduce Nonessential Care

MANAGED CARE June 2012. © MediMedia USA
Editor's Memo

At Last, Providers Are Acting To Reduce Nonessential Care

John Marcille
MANAGED CARE June 2012. ©MediMedia USA

John Marcille

By now, most health-care decision makers are pretty well agreed that more care does not mean better care. And they also are agreed that when a provider charges a higher price, that is not necessarily related to the quality of the service.

But at the same time, we are greatly challenged by the fee-for-service method of payment and its perverse incentive to do more so as to be paid more. Of course the physician or the hospital would never order unneeded tests, procedures, drugs, images just to make money; you and I know that. Yet that CT scan might show something significant; that mammogram for a 40-year-old woman with no risk factors — it’s not as if youngish women never have breast cancer, now is it?

It’s rare that a health care story leads off the national network news broadcasts, but that’s what happened with the recommendation by the U.S. Preventive Services Task Force that the PSA test for prostate cancer not be performed routinely anymore for men of any age. This decision, long in the making, caps a long reassessment by the task force.

So, another instance of more but not better. (Yes, I know, urologists tend to disagree with the recommendation. Even my primary care doc isn’t going along with it, although he isn’t actually forcing me to take the test.)

On another, very promising front, in a program called Choosing Wisely, nine medical specialty societies recommended that physicians perform 45 common tests and procedures less often, and at least eight other specialty societies plan to join the movement in the fall. As our story by Managing Editor Frank Diamond points out, health plans have long been concerned and have subjected some of these to prior authorization.

Still, it’s good to know that insurers are no longer the only ones pointing to waste.

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Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
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2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
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World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
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Home Care Leadership Summit Atlanta, GA November 17–18, 2014