So long as the battery holds out and I don't lose the WiFi connection yet again, I'll send a brief postcard from the National Physicians Alliance annual meeting (actually from National Airport, on my way back home, as I unfortunately was unable to stay for much of the meeting). Those of you who don't know the NPA:
--should check out their excellent Unbranded Doctor Campaign that gives practitioners the resources to develop a drug-rep-and-sample-free office. The NPA has been very active in promoting health reform, physician professionalism, and physician-led cost containment. It was the latter issue that I was invited to speak about on a panel.
Among the many delightful people I met in person for the first time at the meeting, another panelist was Dr. Rita Redberg, the UCSF cardiologist who is editor of Archives of Internal Medicine and there pioneered the superb "Less Is More" feature, providing evidence in support of reducing the overuse of non-beneficial tests and treatments. NPA formed the Good Stewardship group that assembled panels from the three main primary care specialties and asked each to compile a "Top Five List" of the most frequently used interventions in each field that could be eliminated so as to improve the quality of patient care. The focus in that publication was quality, not cost--noting that when unnecessary and nonbeneficial tests or treatments are used, the patient may suffer harm without any compensating benefit.
What we learned today from Dr. Redberg is that in a new study, published on line today in Archives, Dr. Minal Kale and colleagues proceeded to do the cost calculations from the three primary care "Top Five" lists. (subscription required) They utilized conservative estimates to conclude that the total annual savings from eliminating these useless tests and treatments would be about $6.7B. There are two main take home messages in my view. First, this tends to support the view that primary care is not the cost-overrun problem in American medicine. Given estimates from groups such as the Institute of Medicine that we throw away annually some $760B in tests and treatments that produce no patient benefit, what primary care contributes is chump change. Still, if we want the big spenders like cardiology and orthopedics to mend their ways, it is very good that primary care looked at itself in the mirror first and called on the other specialties to do likewise.
The second take home message is that one single item on the Top Five list from internal medicine accounted for the lion's share of the total cost--the recommendation that physicians prescribe generic rather than name brand statins would alone save the country more than $5B. This in turn highlights the low-hanging-fruit issue, that it behooves us in cutting the costs of health care to make care more affordable for everyone to seek out these relatively small and simple steps that can save the most money without harming patients. It also reminds us once again how often picking the low hanging fruit will cause us to go contrary to the messages sent out by Pharma marketing.
We learned from Dr. Steve Smith, head of the Good Stewardship effort, that NPA now plans to produce videos for office use, helping physicians to explain to patients why they don't need some of these expensive but useless tests and treatments. This is a good example of NPA's view-from-the-trenches approach that picks out the critical steps needed to put good ideas into practical action.
Kale MS, Bishop TF, Federman AD, Keyhani S. Top 5 lists top $5 billion. Archives of Internal Medicine, doi:10.1001/archinternmed.2011.501, published on line 10/1/11
Good Stewardship Working Group. The top 5 lists in primary care--meeting the challenges of professionalism. Archives of Internal Medicine 171:1385-90, 2011;