What Breast Cancer Screenings Reveal about Cost Control

Elyas Bakhtiari, for HealthLeaders Media , November 19, 2009

What's left unsaid: Let's not pretend it's not about money, at least in part. If women in certain age groups are getting mammograms half as often, it's easy enough to do the math for how that will affect the physicians who perform a high-volume of the procedure. It's tempting to blame the fee-for-service system or criticize the evidence. But there are times when a group of physicians looks at the evidence and looks at the revenue loss, and decides against what's best for the patient.

What they say: Comparative effectiveness research will ideally help physicians get better value—defined by the best quality at the least cost—out of their healthcare decisions. Even without "rationing care," CER can improve healthcare by giving doctors better information when making decisions. Instead of one-sided reports from drug or device companies, they would have a broad analysis of how a treatment performs when compared to alternatives.

What's left unsaid: The task force says cost was not considered in its research, and Health and Human Services Secretary Kathleen Sebelius said the recommendation is in no way government policy. But it's difficult to believe that will always be the case. Those false positives waste money, after all.

Statistics can be manipulated, and studies can be flawed. For instance, there don't seem to be any radiologists or oncologists currently on the USPSTF. Could that have affected their interpretation of the findings? Furthermore, how will the government respond if it issues guidelines based on scientific evidence and providers don't follow them? At some point, the debate over rationing and mandating care protocols may come back up.

This is just the beginning. There are similar questions about prostate cancer screenings, colonoscopies, and other procedures. Comparative effectiveness research is a solid idea, but it is going to be tough to implement. And even if it's effective, it will only get at a fraction of the cost problem.

Expanding access? It's tough politics, but easy enough. Improving quality is a challenge but many providers are making giant strides. Controlling costs, however, will prove to be the biggest challenge in remaking healthcare, and everyone involved in the system shares a little of the blame.

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Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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