For weeks now, the nation has been riveted by arguments in the U.S. Supreme Court over one provision of the Affordable Care Act. Does the law's requirement that every adult buy health insurance violate the U.S. Constitution?
We think it does not.
Yet even if the court ultimately shares that view, the federal health care reform law will face monumental hurdles to be successfully implemented. The biggest of these is its cost. Can the nation afford to insure all its citizens? If we don't get a handle on rising health care costs the answer to that more important question is an emphatic "no."
And that's what makes last week's announcement by physicians representing nine medical specialties so welcome. The physicians have identified 45 specific medical tests and procedures, five within each specialty, which they think are either overused or misused. They are either unnecessary, lacking benefits to patients or, in some cases, even harmful.
The most commonly overused procedure sited in the report include:
EKGs and other heart screening tests performed on patients with no evidence of risk.
Chest X-rays for patients undergoing outpatient surgery who are otherwise healthy adults with no cardiac symptoms.
CT scans or antibiotics for patients with mild or moderate sinus infections.
Routine cancer screening for dialysis patients, particularly those with limited life expectancies.
Bone scans on women under 65 and men under 70 years of age.
Extensive diagnostic tests for people with allergies.
CT scans and other imaging procedures for simple headaches.
Such tests and procedures rarely benefit patients. Worse, they can cause harm or lead to false positives and over treatment.
These overused and misused procedures add billions of dollars to the nation's health care cost every year, burdening businesses and individuals and sapping the nation's economic vitality. Some experts estimate that as much as 30 percent of health care spending in the United States is wasted.
"Choosing Wisely" is the name of the new health care initiative sponsored by the American Board of Internal Medicine Foundation.
The nine medical societies that compiled the list of suspect tests and procedures are not asking physicians to stop performing those procedures. Rather the lists are seen as a way to stimulate patient-doctor conversations that can lead to a more rational use of our limited medical resources.
The lists give doctors who are being pressured by patients to go beyond what is medically reasonable the support they need to convey hard truths to patients and their families. Ralph deVere White, director of the highly respected UC Davis Cancer Center, welcomes the initiative. The American Society of Clinical Oncologists is among the medical societies that participated, listing one of the more controversial procedures chemotherapy for late-stage cancer patients.
Cancer patients nearing the end of their lives might live longer and enjoy a better quality of life, the oncologists advised, if they go into hospice instead of undergoing another round of debilitating and expensive chemotherapy.
DeVere White says the physicians at the Davis Cancer Center have been offering such advice at its clinics for a number of years. "Without more rational use of resources," he worries, "we are going to run out of money."
So far nine medical specialities representing nearly 375,000 physicians have participated in the Choosing Wisely initiative. They are only the first. Eight more medical societies have announced they will release their lists of overused tests and procedures by the fall.
These lists are not mandates nor are they a prelude to health care rationing. Rather, they provide the necessary impetus for painful discussions medical practitioners need to have with their patients, not just about costs but about the limits of medical science.