Posted on 09/01/2009 3:11:44 PM PDT by Chickensoup
From Medscape Internal Medicine Seven Ways to Reduce Unnecessary Medical Costs -- Right Now! George D. Lundberg, MD
I believe that there are still many ethical and professional American physicians and many intelligent American patients who are capable of, in an alliance of patients and physicians, doing "the right things." Their combined clout is being underestimated in the current debate on healthcare reform.
Efforts to control costs in the US healthcare system date from at least 1932. With few exceptions, they have failed. Healthcare reform, 2009 politics-style, is again in trouble over cost control. It will really be a shame if we once again fail to cover the uninsured because of hang-ups over costs.
Physician decisions drive most expenditures in the US healthcare system. In this system, costs will never be controlled until most physicians are no longer paid fees for specific services. The lure of economic incentives to provide care that is unnecessary, unproven, or even known to be ineffective encourages many physicians to make the lucrative choice. Hospitals and especially academic medical centers are also motivated to profit from many expensive procedures. Alternative payment forms used in integrated multispecialty delivery systems, such as those at Geisinger, Mayo, and Kaiser Permanente, are far more efficient and effective.
Fee-for-service incentives are a key reason why at least 30% of the $2.5 trillion expended annually for US healthcare is unnecessary. Eliminating that waste could save $750 billion annually, with no harm to patient outcomes.
Currently, several House and Senate bills include various proposals to lower costs. But they are tepid at best and in danger of being bought out by special interests at worst.
So what can we in the United States do right now to begin to cut healthcare costs?
An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big-ticket items, saving vast sums while improving quality of care.
Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually. The same for invasive angioplasty and stenting (currently around 1 million procedures per year), saving tens of billions of dollars annually. Nonindicated prostate-specific antigen screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most cases of prostate cancer should also cease because it causes more harm than good. Billions saved here. Screening mammography should be stopped in women younger than 50 who have no clinical indication and sharply curtailed for those over 50, because it now seems to lead to at least as much harm as good. More billions saved. Computed tomography and magnetic resonance imaging scans are impressive art forms and can be useful clinically. However, their use to guide therapeutic decisions is unnecessary much of the time. Such expensive diagnostic tests should not be paid for on a case-by-case basis but could be bundled together with other diagnostic tests by some capitated or packaged method that is use-neutral. More billions saved. . We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved. Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy that only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved. Why might many physicians, their patients, and their institutions suddenly now change these established behaviors? Patriotism, recognition of new science, stewardship, and the economic survival of the America we love. No legislation is necessary to effect these huge savings. Physicians, patients, and their institutions need only take a good, hard look in the mirror and then follow the medical science that most benefits patients and the public health at lowest cost. Academic medical centers should take the lead, rather than continuing to teach new doctors to "take the money and run."
Physicians can reaffirm their professionalism with sound ethical behavior and without undue concern for meeting revenue needs. The interests of the patients and the public must again supersede the self-interest of the learned professional.
George Lundberg, MD Dr. Lundberg is president and board chair of The Lundberg Institute.
George D. Lundberg, MD Consulting Professor, Health Research Policy and Pathology, Stanford Medical School, Los Gatos, California
another facet and attempt of astroturfing from omomma’s masters
Don’t send me there!
It is ...YOUR CHOICE... right?
one Board member....an Emmanuel
Linda L. Emanuel, MD, PhD, received her PhD from University College, London, and her MD from Harvard. She worked in General Medicine, Public Health and Ethics in Boston prior to becoming the first Director of the Ethics Institute at the American Medical Association. Now Professor of Geriatric Medicine at the Buehler Center on Aging at Northwestern University, Dr. Emanuel is an eminent authority on ethics and medical practice in palliative care.
Raul’s sister?
I sure don’t want them as my doctor!
yep....Linda and Ezekiel
Understanding Economic and Other Burdens of Terminal Illness:
The Experience of Patients and Their Caregivers
Ezekiel J. Emanuel, MD, PhD; Diane L. Fairclough, DPH; Julia Slutsman, BA; and
Linda L. Emanuel, MD, PhD
Background: Terminal illness imposes substantial burdens—
economic and otherwise—on patients and caregivers.
The cause of these burdens is not understood.
Objective: To determine the mechanism for economic
and noneconomic burdens of terminal illne
snip
http://www.annals.org/cgi/reprint/132/6/451.pdf
We're senior citizens and take no drugs and are in far better shape than most of our peers.
I have insurance and could be going to the doctor but I feel I am better off not going. I'm sure they'd find a reason to put me on a drug of some kind and I personally feel that most drugs do as much harm as good. I have the stories to back up my opinions.
Taxpayers do not have to ever worry about paying for chemo for me.
Interesting Raul is throwing business into his family’s way. If this catches on they will gobble up grants and speaking fees.
The easy part is telling a patient to their face”go home and die”
Hopefully we can get Dr Lundberg to volunteer to perform that “heart to heart “ for all of our patients.
Whenever you restrict any treatment and take away the choice of the patient then you become the slur most physicians despise the most, playing God
Actually, chemo for stage four cancer is only useful if it is pallitive and stops pain.
I agree, sometimes we just need to realize we are going to die.
Whenever you restrict any treatment and take away the choice of the patient then you become the slur most physicians despise the most, playing God
In medicine people are told everyday that they have little or no chance to live. Severe burn victims are kept comfortable and not treated because there is little/no chance of keepng them alive. They have no choice to try. Heart patients are told that heart surgery is too risky and that they should put their affairs in order. Liver cancer patients are told that they will not get transplants. It is.
The quickest way to reduce your health care cost is to die...
I guess the issue that bothers me is that for many years patients and families have quietly decided to stop rescue and agressive care. IT is not a state issue. It is not even a medical organizaion (read non profit sponge) issue. It is a personal issue born of relationships.
Amen to everything you said!
I have made it official in my will, no extraordinary means to keep me alive and then I list the extraordinary means...Told my kids I may be old but just might get a tattoo on my old chest that says in big letters NO CODE.
They kinda of chuckle, but know I just may do it...
I'm interested in finding out more about intravenous Vit C. I understand it's effective for pain and I know it has worked miracles for my sore shoulder and hip.
Of course, I only take 4 grams daily and intravenous is given in far greater amounts than this. But it still looks promising for many ailments.
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