Strategies to Avoid 5 Highly Overused Treatments

Leigh Page

July 16, 2013

In This Article

At a time when healthcare providers are worrying about possible cutbacks in payments, physicians and hospitals are stepping up efforts to identify and avoid unnecessary procedures that add to the nation's healthcare bill and pose unnecessary risks for patients.

On July 8, a national summit involving a wide sweep of medical groups, as well as hospital organizations, government agencies, and public interest organizations, issued a policy paper detailing strategies for dealing with 5 overused treatments that can harm patient safety and quality: antibiotics for the common cold, blood transfusions, ear tubes for children, early-scheduled births, and cardiac stents.

The National Summit on Overuse, which met on September 24, 2012, in Chicago, Illinois, was organized by the Joint Commission and the American Medical Association's Physician Consortium for Performance Improvement (PCPI), which develops evidence-based clinical performance measures. Five separate advisory panels examined the 5 areas of overuse and delivered their reports in the newly released paper.

The goals of the summit were to reduce risks to patients, improve care, and discourage waste of resources, according to Richard Hellman, MD, clinical professor of medicine at the University of Missouri Kansas City and vice chair of the PCPI.

"The idea was to bring specialists and primary care physicians together and try to develop standards across medicine," he said. "This is based on the realization that some care is expensive and can be harmful."

For example, it costs about $25,000 to implant a stent, and an early-scheduled birth with a caesarean section can cost $28,000 compared with $18,500 for a vaginal delivery. Implanting ear tubes in children is the most common surgical procedure in the country, costing a total of $2 billion a year, and unnecessary antibiotic prescriptions for upper respiratory infections cost an estimated $1 billion annually.

Dr. Hellman said there is mounting evidence that all of these treatments are often unnecessary. Treatments always come with risks, which are acceptable if they can improve a patient's condition, but the risks are not acceptable if there are no benefits, he said.

Relevant specialty societies and public interest groups have already issued reports recognizing overuse of these treatments and issuing criteria for assessing their use, but these reports are not always aligned with each other, Dr. Hellman noted.

The advisory panels called for standardizing reporting data, aligning current guidelines with each other, disseminating best practices to physicians, and educating patients. Experts said patients are a key audience because they may even pressure their physicians to approve treatments.

In some cases, law enforcement is cracking down on physicians who overuse treatments. For example, 3 US cardiologists have been criminally prosecuted for healthcare fraud related to the placement of heart stents. In June, a Kentucky cardiologist pleaded guilty to fraudulent placement of stents; he will serve between 30 and 37 months in federal prison.


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