Could the Pandemic Put an End to Medical Overtreatment?

Leonard Feld, M.D., Ph.D., M.M.M.

,
Minal Patel, M.D., M.P.H.

COVID-19 pandemic may present an opportunity to hit a reset button on American healthcare that could winnow out unnecessary, wasteful services and prescriptions.

Several years ago, more than 2,000 physicians indicated in a survey that significant proportion of medical care is unnecessary and ineffectual. Responses to the survey suggests that more than a fifth of overall medical care is unnecessary as is more than a fifth of all prescribed medications. The same is true of nearly a quarter of all tests, the responses suggest, and more than 11% of all procedures. Malpractice, patient demand and the difficulty of accessing medical records were cited as the top reasons for this bloat and waste in our healthcare system.

The costs associated with unnecessary care easily pass $200 billion per year, according to the Institute of Medicine.

Waste in our healthcare system can be categorized as administrative, operational or clinical.If we itemize waste and cost as duplication of services, medical errors, or operational inefficiency that is detrimental or unneeded, it is obvious that other industries would have long ago chopped these expenditures.

The good news is that moving away from the fee-for-service model toward value-based care gets us part of the way toward a more cost-effective healthcare system because it removes the incentive to provide care that is duplicative or unnecessary.

But we have the opportunity today to go further. The pandemic, for better or for worse, has hit a giant reset button on our country’s healthcare utilization. Americans are postponing wellness visits, childhood immunizations, diagnostic testing and surgical procedures. People with chronic diseases such as diabetes and heart disease have put off appointments with specialists.

With patients by and large staying home, now is the ideal time to re-evaluate our healthcare system.

When they begin returning in larger numbers to the physician offices, clinics, and hospitals, they should be doing so only for the care they need. Patients will be venturing from home to get back to in-person care.

This is our chance to make sure that waste and ineffectual healthcare are left behind when something close to normal healthcare resumes.

The reset button

In our current environment, healthcare leaders have the chance to design a new vector or hit the reset button on strategies to achieve long-term financial sustainability and resilience in case of future unanticipated health crises. They should take a hard look at care delivery in the past, separate out unneeded care and take steps to make sure it doesn’t come back when healthcare as a whole springs back to life. It is only high-quality, cost-effective care we bring back with a vengeance.

So how should healthcare decision-makers approach this challenging of winnowing out unnecessary healthcare?

Healthcare leaders have been discussing this for quite some time, and the range of different approaches can be boiled down to four areas along with steps that healthcare organizations can take.

1. Information technology

Healthcare leaders should reassess their organizations’ information systems and data capabilities and ask:

  • Can we stop, pause or override duplicate testing or procedures at the point of ordering?
  • Can all team members view the expenses related to testing and procedures before final order entry?
  • Are expense profiles distributed on a quarterly basis to healthcare providers?

2. Evidence-based medical assessment and total outcomes review

Healthcare organizations should conduct a thorough analysis of all current protocols, guidelines, algorithms and standing order sets to make sure they are linked to expense profiles and benefit the risk-scoring assessment system. Outcome assessments should link back to technology integration and evidence-based medical assessment to weigh new opportunities, maintain long-term sustainability and identify any barriers to success using quality improvement process tools.

3. Social determinants of health

Organizations should conduct a detailed analysis of the key categories of social determinants of health (SDOH) and their elements, then decide how many can be implemented and on what timeframe. Which of these programs will require a partner in order to successfully implement? Goals related to the value and impact of SDOH should be reset quarterly.

4. True population health

Healthcare leaders should develop a straightforward method to disseminate results and outcomes with all team members for the benefit of the communities their organizations serve. This will move us toward more “holistic” healthcare.

Waste and unnecessary care has plagued our healthcare system for years. Just as patients must stop asking for treatments they don’t really need, we must stop offering it. The key to making that happen will be better analysis and dissemination of important health data, followed by a slew of new policies.

When patients return to the clinics and the medical centers, there’s no reason they should be bringing our healthcare system’s chronic wasteful ways with them.

Leonard Feld, a senior healthcare executive, is a director for healthcare strategy for GuideHouse.

Minal Patel, a serial physician entrepreneur, is currently co-founder and CEO of a health IT company, Abacus Insights.