- Routine EKGs, especially when there is no chest pain present
- MRIs for back pain
- Antibiotics for mild sinusitis
- Routine stress tests
- Imaging for headaches
- Higher doses of meds to control acid reflux
- Scans for early prostrate cancer
- Scans for early breast cancer
- Scans for early kidney disease
We here at the RT cave are debating whether or not this is good. There are three arguments:
1. Is the attempt to end medical waste coming from physicians?
The proof: As noted by the article, "The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States." The cost of wasted treatment and hospitalizations exceed $2 trillion.
The debate: Ask just about any RT and he or she will verify that most of what respiratory therapists do is not necessary, which would include:
1. Is the attempt to end medical waste coming from physicians?
The proof: As noted by the article, "The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States." The cost of wasted treatment and hospitalizations exceed $2 trillion.
The debate: Ask just about any RT and he or she will verify that most of what respiratory therapists do is not necessary, which would include:
- Bronchodilators for any condition other than bronchospasm
- Routine EKGs
- Routine Stress Tests
- ABGs for sepsis and Pulmonary Embolism
A panel of physicians recommending fewer of the above, and asking patients to question any such order, would be a good thing. It would end wasted medical spending and burnout of those performing these tests.
2. Is the end the result of payers to cut costs?
The proof: As noted by Rabin: "Insurers and other payers are seeking to shift more of their financial pain to providers like hospitals and physician practices, and efforts are being made to reduce financial incentives for doctors to run more tests."
The debate; If the payer is forcing medical cutbacks, many think the recommendations are a form of death panels. Instead of a doctor giving an old lady a preventative test that could save her life, doctors may simply recommend a pain pill and to give up. If this is the decision of the physician and patient, I'm fine with it. Yet if it's the decision of the payer, I'm against it, and so should you. One size fits all medical policies (i.e. ordersets) can be a detriment to good medical care and overburden to health professionals.
3. Will it result in less profit for doctors?
The proof: Wasted hospitalizations and tests result in $2 trillions of dollars to the medical community. Not doing the above procedures would greatly cut into a doctors profits.
The debate: See the proof. In the past doctors have rejected such recommendations on the grounds that they know what's best for their patients and not a panel. However, in recent years government and insurance agencies have come down on physicians due to the high cost of wasted procedures, and physicians must comply in order to get reimbursed.
What do you think?
1. Rabin, Roni Caryn, "Doctor Panel Recommends Fewer Tests for Patients," New York Times, April 4, 2012
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