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Medicare, We Have A (Big?) Problem

Fri, 06/06/2014 - 10:43am
Mike Schmidt, Editor, Surgical Products

This column will appear in the upcoming July-August print issue of Surgical Products.

It’s not a question of if Medicare patients are receiving unnecessary treatments and procedures. It’s a question of how many.

Or so says a recent study conducted by Harvard Medical School researchers and published last month in JAMA Internal Medicine. Researchers found 42 percent of Medicare patients received at least one unnecessary medical procedure in a single year, and that the cost of this care totals roughly $8 billion.

The data comes from a 2009 analysis of Medicare claims for 1.3 million patients. Harvard Medical school researchers closely examined the claims and developed a list of 26 “low-value” procedures they deemed to reflect overuse after consulting research evidence and taking into account recommendations from several medical groups.

The methodology employed by the researchers compelled me to wonder about the statistics included in the results, especially because the individuals who conducted the study went so far as to release findings of an additional analysis of the Medicare claims (where more conservative criteria were used to determine the necessity of treatments and procedures). Those results indicated only 25 percent of Medicare patients got at least one unneeded procedure, and the cost added up to about $2 million.

While it would be foolish to argue against the assertion that some Medicare patients are being overtreated, the extent of the problem is very much in question. This is not to suggest that the lack of unassailable qualitative data should serve to mitigate the seriousness of the problem of unnecessary healthcare treatment and cost in this country, nor should it serve as an excuse to ignore it until additional data paints a clearer picture of the problem. I believe, however, it is quite difficult to solve a problem of great significance when said problem is not fully defined or measured. Overtreatment in healthcare is not an issue exclusive to Medicare patients. A 2012 Institute of Medicine report that focused on healthcare spending in the United States determined approximately 30 percent of spending (or $750 billion) was related to overtreatment or unnecessary cost.

Does a solution begin with educating patients about the importance of understanding their illnesses, injuries, and ailments to ensure they are receiving an appropriate amount of care? Does it begin with curbing overzealous doctors who order more treatments and procedures to bring in additional revenue and sidestep potential malpractice lawsuits? These are difficult questions, and there is no easy way to go about answering them without a better understanding of the scope of this problem.

Simply stated, we're not there yet.


What's your take? E-mail me at mike.schmidt@advantagemedia.com  or respond on Twitter @MikeSchmidt_SP.

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