California healthcare purchasers team up to tackle the US' $200B medical waste problem
- The U.S. wastes at least $200 billion a year on excess medical tests and treatments, Kaiser Health News reported. Not only is this costly, but it contributes to some 30,000 deaths each year due to errors and injuries.
- To change physician behavior, California Public Employees’ Retirement System, Covered California and the state’s Medi-Cal program have teamed up to promote safer, more cost-effective care. Together, they serve more than 15 million patients.
- Known as Smart Care California, the coalition is initially focused on reducing elective cesarean sections, opioid use and overtreatment for patients with lower back pain.
Efforts to reduce unnecessary tests and treatments, such as the Choosing Wisely campaign, have been hampered in part by the "therapeutic illusion," according to Dr. David Casarett, an associate professor at the University of Pennsylvania’s Perelman School of Medicine, who wrote about the phenomenon in the New England Journal of Medicine last year. The tendency leads doctors’ to over-estimate the impact of their actions, much like a gambler might over-estimate their odds of winning a card game.
In 2014, doctors ordered more than $9,500 in the tests and treatments per capita in the U.S., pushing total healthcare spending up 5.3% from the previous year — partly as a result of this illusion of control.
A 2015 study found three out of seven “low value” health services had declined since 2012, but other had stayed the same or even increased. Using claims data from Anthem-affiliated Blue Cross and Blue Shield Plans, the analysis showed drops in orders for imaging for headaches, heart imaging for people without a history of heart conditions and antibiotics for sinusitis.
During the same time, however, use of preoperative chest X-rays and imaging for lower back pain remained the same, and use of prescription nonsteroidal anti-inflammatory drugs and HIV testing for women under age 30 actually increased.
Groups like the Choosing Wisely Campaign urge doctors to explore why particular tests or treatments seem effective, as well as signs of failure, to cut down on over treatment.