How can we cut the waste in healthcare? To be part of the solution, are we willing to focus on overall wellness and plan our own end-of-life care?
By David Martin, President and CEO of VeinInnovations
Last week, I wrote an article about low and no-value care (unnecessary care) in American healthcare. This week, I continue the conversation. In a system that struggles to cut costs, reducing the amount of unneeded services would have a major impact. In 2011, we spent $2.6 trillion on healthcare and about one third of that – $750 billion – was classified as unnecessary.
From a purely economic perspective, it’s unsustainable. Our country can’t continue to spend as much as we do on healthcare. Especially when we consider that our high spending does not result in health outcomes that are enviable around the globe.
This waste is also destructive in other, more personal ways. In his article, Overkill, Atul Gawande argues that unnecessary care crowds out providing necessary care. What is better for a patient struggling to control diabetes? A trip to the emergency room for standard testing, or a good talk with their doctor and a 45-minute visit with a diabetes educator? In Overkill, Gawande makes a compelling argument for the latter.
A new kind of care system, where the focus is on overall wellness and not fee-for-service, is beginning in fits and bursts in the United States. Physicians, more aware of the epidemic of unnecessary care, are trying to do less. To make greater change, some of the mentality about healthcare needs to shift as well. We believe that more is always better. It’s why, when we need some pain relief, many of us take two ibuprofen pills instead of the one that will suffice. It’s why, when we have a headache, we sometimes request a CT scan or MRI we don’t need.
The belief that more is better is a huge driver of demand for wearables. I’ve written that the market for wearable health devices is exploding. It still is as people are eager to track sleep cycles, exercise, blood pressure, and more. Our faith in technology is high, but it’s perhaps a bit too optimistic. All that data you’ve collected with your Jawbone? It might not be useful to your doctor.
Increasing technological capabilities pose another challenge you might not expect. If you’re not sick as you’re reading this sentence, you (hopefully) feel fine and dandy. You’re probably hoping to get out of the house or office and enjoy the summer day. You feel good. You also, more likely than not, harbor some kind of abnormality, either biochemical or structural, in your body. Don’t panic! You’re fine. You don’t need treatment and you’re not in danger. You’re just human, a living, breathing organism.
New tech means that we catch abnormalities that aren’t a true cause for concern. Additionally, so many tests mean that false positives will happen more often. Knowing, intellectually, that an abnormality may be just that and nothing else is cold comfort. When a doctor tells you they’ve found cancer in your body, even a small amount that is unlikely to grow and cause problems, you’ll probably have a hard time accepting that the best treatment may be no treatment at all.
In recent years, medical communities have begun trying to combat unnecessary care. The Choosing Wisely campaign reaches out to doctors and patients, aiming to get them talking about appropriate and needed care. In the last few years, Choosing Wisely has received hundreds of recommendations from doctors about unnecessary tests and ways to reduce waste. Their lists are a terrific resource for patients. From their site: “The Choosing Wisely lists were created by national medical specialty societies and represent specific, evidence-based recommendations clinicians and patients should discuss. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.” Follow this link to have a look. It’s a good beginning, at least, though larger changes will be needed to truly tackle waste.
That larger change may be hard to get. You’ll recall the “death panels” that were so fiercely fought over? The name is rightly terrifying; the program it was used to describe encouraged physicians to speak to patients about end-of-life care. The drama around it was part of what resulted in end-of-life care being ejected from the Affordable Care Act legislation. This is a shame, because nationally, only 30 percent of adults have made plans for medical care at the end of their lives. Without a clear statement of your wishes, your children and loved ones are left to make heart-wrenching decisions in the midst of their grief. When you have an honest look at your values, and think about interventions at the end of life, most people will say: enough. We ask for our deaths to be dignified, and for a gentle, peaceful end. That means less intervention, which, practically speaking, translates to much lower costs to our families and the healthcare system at large. If the idea of planning your death stills seems too macabre to complete, please have a listen to this Planet Money podcast about LaCrosse, Wisconsin, where 96 percent of adults have made plans. And read my article about the struggle of families to make medical decisions for a dying loved one.
For now, reducing waste in medicine is happening in small increments. But many physicians (and increasingly, patients) are dedicated to ending the waste. So the next time you go to the doctor, be part of the conversation. Take a list from Choosing Wisely and do what the organization is trying to help you achieve: make a wise decision with your doctor.