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Four Ways Hospitals Can Cut Unnecessary Care and Improve Patient Outcomes

Providers must work with patients to stop treatments that don’t work, expert says

A significant amount of the health care administered each year to patients in the U.S. is unnecessary, expensive, and ends up doing more harm than good, according to an essay in Forbes.

Robert Pearl, MD, CEO of the Permanente Medical Group, outlines four ways to reduce unnecessary patient care, ultimately saving families and providers money, and also empowering patients by giving them options in their care plans.

Because of the country’s pay-for-service care model, Pearl says physicians have a “perverse incentive” to provide the most aggressive, expensive care possible, even in situations where a “wait-and-see” approach or a less-invasive care plan would work better.

For example, he notes that a 2011 study in the Journal of the American Medical Association found that up to 23% of cardiac pacemakers are installed unnecessarily. Moreover, thousands of patients udergo surgical approaches to lower-back pain every year, having lumbar fusions and disc removals in spite of little evidence that these procedures work.

Pearl also writes that health care providers often “harm the dying” by imposing aggressive lifesaving measures when palliative care would be more appropriate. Chemotherapy and dialysis treatments often make very ill patients sicker in their final days –– and yet clinicians order them even when the invasive treatments are doomed to fail.

Pearl says the industry could reduce unnecessary patient care by taking four steps:

1. Empower patient decision-making.

Clinicians should give patients a realistic idea of how likely it is that a procedure or medication will work, as well as an opportunity to discuss how likely the patients would be to experience complications.

2. Shift to value-based pay practices.

This would eliminate the incentive for doctors to choose the approach that will make them the most money, rather than the approach that is best for patients.

3. Determine when new approaches are actually better.

Most patients want to try the newest procedure they’ve heard about or the drug they saw advertised on TV, but in many cases more conservative measures are in order. A new treatment doesn’t necessarily mean it’s better, Pearl says.

4. Reform medical malpractice.

Many physicians will do too much for patients for fear of missing an unlikely problem or of being sued, according to Pearl. “Making malpractice litigation and awards more rational would be better for the health care system in general and patients in particular,” he says.

Sources: FierceHealthcare; July 10, 2015; and Forbes; July 9, 2015.

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