Friday, September 26, 2014

Wachter and Gibson on overuse

Here's a superb conversation between two of the world's experts, Robert Wachter and Rosemary Gibson, on the following issue: What is the magnitude of overuse in medicine?  And what to do about it.  The depth of their knowledge and understanding is something to behold. This should be required reading for all in the health care world.

The opening [but keep reading!]:

Dr. Robert Wachter, Editor, AHRQ WebM&M: What is the magnitude of overuse in medicine? 
Rosemary Gibson: We don't measure the extent of overuse so we don't know its magnitude. I believe it is pervasive.
RW: As you look at the pathophysiology of it, are you convinced that financial drivers—which I guess I interpret as being the more you do the more you get paid—are the dominant reason for overuse? What evidence supports that?
RG: Yes, financial incentives are the dominant cause of overuse. But other factors contribute to overuse. Uncertainty in medicine drives overuse. A natural proclivity may be to do something in a context of uncertainty. Fear of malpractice suits drives overuse. Beliefs are a factor. Physicians and patients have their beliefs about medicine and its possibilities and limitations.


Barry Carol said...

That was a terrific conversation.

One issue that wasn’t covered that I think would be helpful would be to find ways to get doctors to view knowing and caring about the cost of their treatment recommendations as part of their job. Another would be to get hospital systems to stop defining physician productivity as relative value units billed and using that as the key metric to determine bonus compensation.

Price transparency and lower patient copays for choosing more cost-effective providers would be helpful in getting more value for our money but patients and referring doctors can’t choose wisely without price transparency.

Finally, perhaps more hospital systems should get into the health insurance business. Then the hospital suddenly becomes a cost center instead of a profit center.

Neville Sarkari MD, FACP said...

Great read. Thanks for sharing!