Has the value-based U.S. healthcare system become so focused on the bottom line that care is, in cases, getting compromised? 

It surely happens. National health expenditures hit $3.5 trillion in 2017. That’s $10,739 per person and 17.9 percent of GDP. In a spend that massive, there’s got to be plenty of waste ripe for the cutting. 

But sometimes one person’s unthrifty healthcare spending is another’s must-have care. 

Here’s an example. In what I’d place under the heading of “I’m glad I don’t have to make those kinds of decisions,” it turns out cancer patients who are in palliative care programs receive no less imaging during the last three months of life than those who are not in such programs. And the utilization remains consistent in the very last month of life. The findings come from researchers at UC-San Francisco as reported at RadiologyBusiness.com. 

Across the Atlantic, researchers found U.K. infants had a mean ER treatment cost of around $1,310 per patient when the aim was to figure out the cause of a fever. The same thing cost just $208 for children between 3 and 6 years old. The disparity clearly has something to do with providers’ anxiety dealing with patients who can’t explain how they feel. In fact, the data showed a lot of doctors ordering a lot of tests and antibiotics on a just-in-case basis. 

Improving care while cutting costs won’t be easy. But we have to take a shot at it. For starters, consider the role physician extenders can play. (Cover story.)

Add transparency. Dr. Nick Argy has radiology-specific ideas. 

Bigger picture, a nation turns its anxious eyes to Atul Gawande. 

The Boston surgeon and bestselling author is the individual hand-picked by tycoons Jeff Bezos, Warren Buffet and Jamie Dimon to lead the way. They’re now calling their heavily publicized venture Haven and clarifying that its mission is to “transform healthcare to create better outcomes and overall experience, as well as lower costs for you and your family.” 

Will Haven make a dent? It just might. A decade ago Gawande gave the commencement address at the University of Chicago’s Pritzker School of Medicine. I don’t know if any radiologists-to-be were in attendance that day. But no matter. There’s nothing better to close this spring 2019 note than Gawande’s words from spring 2009—with emphasis added for renewed urgency: 

“No one talks to you about money in medical school or how decisions are really made. But as you look across the spectrum of healthcare in the United States, you come to realize that we are witnessing a battle for the soul of American medicine. And as you become doctors today, I want you to know that … if you serve the needs of your patients, if you work to ensure that both overtreatment and undertreatment are avoided, you will save your patients. You will also save our country. You are our hope.”

P.S. The 2019 Radiology 100 is underway. If you haven’t yet entered, please do so at Radiology100.com as soon as you have 10 minutes. Thanks in advance!