Monday, June 15, 2009

Simple Solutions

There's an old saying that "the most expensive piece of equipment is the doctor's pen." Doctors hate being told what to do, whether it's a government bureaucrat or another doctor. That's why they refuse to accept the common sense of the Dartmouth studies that show variations in Medicare treatments which more than double costs without changing outcomes. The research from the Dartmouth College's Institute of Health Policy and Clinical Practice compares costs and outcomes all across the country and it's caught President Obama's attention as a way to reduce health care costs.

Why would McAllen, Texas, a poor border town, spend $15,000 per year per Medicare patient when Rochester, Minnesota, home of the famous Mayo Clinic, spends half as much? To be fair let's compare it to El Paso since they have similar demographics. El Paso's hospitals rank better than McAllen's is 23 of 25 criteria. Yet McAllen patients get 60% more stress tests with echocardiography, 200% more tests to diagnose carpel tunnel syndrome and 550% more tests to diagnose prostate problems.

Atule Gawande, a Boston surgeon writing in The New Yorker recently said "they get more of what costs more but not more of what they need." Doctors at the Mayo Clinic work on fixed salaries which reduces the incentive for more revenue-producing tests. Developing "best practices" is not only a benefit to patients, it's also one of the ingredients in health care reform.

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