Physicians and the E Word
Physicians are understandably suspicious of efficiency efforts in medicine, but nowhere in the Hippocratic oath are they absolved from addressing the appropriate delivery of care As we gallop toward the culmination of possibly the most entertaining—and important—presidential election in collective memory, the issue of health care emerges and recedes on the national stage. Like the disappearing ducks in a carnival shooting gallery, it mostly recedes. This underscores the difficulty of the challenge ahead: lowering health care costs while extending coverage. Health care providers struggle to define quality, as payors strive to hold down costs. Caught in the middle are the physicians charged with practicing medicine. If medicine were strictly a science, the quality problem would be easier to solve, and if people were androids, manufactured to conform to specifications, the problem would be easier yet to solve and, therefore, regulate. The human animal, however, comes with such a wide range of physical, circumstantial, and genetic variables that the art of medicine is now, and is likely to remain, a decisive resource in the physician’s toolkit. Nonetheless, there also is room in this equation for efficiency. In this environment of high deficits, looming Medicare Trust Fund insufficiencies, and soaring health care costs, it is reasonable to ask: Why is efficiency such a dirty word among physicians? For the answer, I turn to a pilot project commissioned by the country’s largest health care payor, CMS, which aims to develop and vet a number of imaging-efficiency measures that would accomplish improvements in efficiency and, ostensibly, improve the quality of care. Four measures were put forth earlier this year by the Washington, DC-based research and consulting firm L & M Policy Research for comments from the radiology community:
- MRI of the lumbar spine for lower-back pain (the number of patients with lower back pain receiving MRI with antecedent conservative therapy);
- mammography follow-up rates (essentially, call-back rates);
- use of contrast material for CT of the abdomen (the percentage of patients receiving abdominal CT without the use of contrast for the diagnosis of calculi in the kidney, ureter, and/or urinary tract; renal colic; hydronephrosis; and unspecified abdominal pain), with the percentage expected to be high; and
- use of contrast material for CT of the thorax (the percentage of total studies performed with the use of contrast), with the percentage expected to be high.