Are We Missing Gawande's Point?

Philip Betbeze, for HealthLeaders Media , July 31, 2009

Gawande concludes that local variability is rooted in the overuse of services. But it can be easier to make fun of McAllen than it is to turn the mirror on yourself. You don't have to wait for healthcare reform to take action. Here are a few ideas:

  • Do you know where your community stands in the Dartmouth Atlas or other global efficiency metrics?
  • Within your hospital or medical group, have you done an analysis of key diagnostic procedures and orders, particularly to identify gross outliers of overuse by procedure or by provider/group?
  • Have you fixed those outliers within your control?
  • Have you collaborated with other providers in the community to analyze any troubling patterns?
  • If there are community health issues (high rate of diabetes, obesity, smoking, etc.) that contribute to overuse of services, have you initiated a critical review of current community wellness programs and explored ideas for future interventions?

Coordinating care is hard. Developing evidence-based medicine protocols is hard. Ordering tests and surgeries is relatively easy, and it pays a heckuva lot better.

It's no surprise that healthcare costs so much. Outside of some commercial plans that pay close attention to such things, what incentive do doctors and hospitals have not to over-test or over-cut their patients? What incentive do they have to tell their patients "no" when "yes" is so much easier, not to mention more lucrative?

Meanwhile, many folks who are against evidence-based medicine or comparative effectiveness research want to raid the national healthcare cash register with one hand while they use the word "rationing" as an obscenity to belittle those who want to do something to fill in the bottomless pit that healthcare spending has become.

We've known about vast waste in healthcare spending for more than 20 years now.

When are we going to actually do something about it?

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Philip Betbeze is senior leadership editor with HealthLeaders Media.

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