Stop paying for medical tests that don’t improve healthcare


nist.gov image
nist.gov image

by Rosemary Gibson

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The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.

Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine at the Stanford University School of Medicine highlighted seven often unnecessary things done in primary care, such as EKGs in patients without symptoms, that were identified by the Good Stewardship groupconvened by the National Physicians Alliance.

Later, Dr. Steve Weinberger, Executive Vice President and CEO of the American College of Physicians identified sensible principles to guide the integration of a “less is more” theme in public policy, such as:

  • Avoid interventions that don’t help and may harm
  • Give incentives to physicians and patients to avoid low value care
  • Use payment approaches that are politically feasible, medically appropriate and minimally burdensome
  • Recognize that there will always be exceptions.

The discussion addressed the tip of the iceberg. The next step is to move to the big-ticket items where the literature is quite clear that patients are harmed by back surgeries for which there is no evidence of efficacy, cardiac bypass surgeries that are unwarranted, and duplicative and unnecessary diagnostic imaging that exposes patients to cancer-causing radiation, among many other tests and procedures performed that may cause more harm than good.

We can’t put all of the health care reform burden on patients, even with shared decision-making. Physician leadership is essential. That’s why this meeting will hopefully be the first of many conversations on K Street and on Capitol Hill.

In the end, this is all about good care of the patient. That’s the primary motivation. It’s also true that as a society, we don’t have money to waste. As I wrote in The Treatment Trap, the best way to preserve Medicare is to pay for things that improve health and well-being, and to stop paying for things that don’t. If we don’t get it right, and get it right soon, even the good things will be cut. Let’s act on the wisdom we have that knows the difference.

Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation.  She is author of The Treatment Trap and Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans. This article originally appeared on The Medical Professionalism Blog.

Listeria death toll now at 23, making outbreak deadliest in 25 years

By Ryan Jaslow

cantaloupe, listeria
(Credit: Joe Raedle/Getty Images)
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(CBS/AP) The Listeria outbreak from cantaloupes is now the deadliest foodborne illness outbreak in the U.S. in more than 25 years.

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The CDC announced Wednesday that 23 people have died from listeriosis, while another 116 have been sickened. Not since 1985, when Listeria from Mexican-style soft cheeses killed 52 people, has a foodborne illness outbreak been this deadly in America. The current death toll also surpassed a 1998 Listeria outbreak linked to processed meats that killed 21 people.

Officials say the tainted cantaloupes from Jensen Farms in Holly, Colo., should be off store shelves by now, as they were recalled mid-September and their shelf life is about two weeks. But the number of deaths may continue to grow. Symptoms of listeriosis can take up to two months to appear.

The CDC on Wednesday confirmed two more deaths in Louisiana. Other deaths have been reported in Colorado, Indiana, Kansas, Maryland, Missouri, Nebraska, New Mexico, New York, Oklahoma, Texas and Wyoming.

Listeria illnesses have been reported in Alabama, Arkansas, California, Colorado, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Missouri, Montana, Nebraska, New Mexico, New York, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Virginia, West Virginia, Wisconsin and Wyoming.

FDA investigators said that Colorado health officials found Listeria in cantaloupes taken from grocery stores and from a victim’s home that were grown at Jensen Farms. Matching disease strains were found on equipment and cantaloupe samples at Jensen Farms’ packing facility in Granada, Colo. FDA officials have said they were looking at the farm’s water supply and possible animal intrusions among other things to figure out the source of the problem. Listeria grows in moist and muddy conditions, and the bacteria are often are carried by animals.

Jensen shipped the cantaloupes to about half the states, but added that it wasn’t sure where the cantaloupes went because they have been sold and resold. Some companies may be unaware that they bought or distributed the tainted fruit.

Listeria is more deadly than other well-known pathogens such as salmonella and E. coli. While most healthy adults can consume Listeria with no ill effects, it can kill the elderly, those with compromised immune systems, and unborn children of pregnant women. The CDC said the median age of those sickened is 78, and most people who are ill are over 60. The CDC said it is also aware of one miscarriage linked to the outbreak.

Colorado has the most illnesses with 34, while Texas has reported 17.