Washington is one of the most efficient states in the nation when it comes to the delivery of cost-effective health care. However, new statewide analysis shows that many patients still receive unneeded and expensive care. This excess care dramatically adds to the cost of health care — and in some instances could threaten the health of patients.
A recent statewide study conducted by the Washington Health Alliance underscores the need for physicians to adhere to clinical practice guidelines and evidence-based medicine when treating patients and also for patients to be more assertive in directing their own care.
The data is startling. For example, 57 percent of women received pap smears too frequently and 17 percent received pap smears even though they had undergone a hysterectomy. Nearly a third of children with suspected appendicitis were needlessly exposed to radiation from CT scans when an ultrasound would have sufficed. One fourth of all patients with uncomplicated headaches received potentially unneeded CT or MRI scans.
The report also highlighted inappropriate prescription of certain medications. Far too many doctors are still giving antibiotics to treat viral infections even though the medical evidence shows these drugs have no effect.
There are many reasons why patients receive inappropriate care. Consider prescribing antibiotics for viruses, for example. Some doctors may find it hard to tell a patient with a cold that there is no better solution than bed rest. They may feel pressure to offer some sort of perceived relief so they prescribe antibiotics even though science says the treatment will have no benefit.
Some physicians may be so busy delivering care that they have a difficult time staying up to date with the latest standards of care, which are constantly evolving. Still others may order excessive tests because they fear malpractice liability.
All of the findings in the study can be addressed. I know that because at The Everett Clinic, we have devoted much of the last 15 years to tackling the very issues outlined in the study. And while we’re not perfect, we have made great strides in eliminating the waste and costs of unnecessary care.
The advantage of being a larger physician group practice is we have the bandwidth to stay updated with the latest standards of care and share that with our physicians. We also can monitor how care is delivered, counsel physicians on best practices, and encourage our patients to take an active interest in the kind of care they receive.
The Everett Clinic has undertaken many reforms over the years to avoid many of the issues outlined in the Washington Health Alliance study.
We were one of the first medical groups in the nation to ban pharmaceutical companies from doctor’s offices, believing that prescribing medicine should be based on science and medical experience — not advertising and marketing. Instead of allowing pharmaceutical reps to roam our halls, a clinical pharmacy team reviews the latest drugs to determine effectiveness before adding effective drugs to our formulary.
The Clinic was an early adopter of generic drugs. More than 90 percent of medicines prescribed for patients are less expensive generic drugs. This approach saves an estimated $100 million a year compared to the Washington state average.
We have developed standardized, evidence-based protocols for advanced imaging such as MRIs. This has resulted in a reduction of imaging services by 39 percent, saving the clinic, patients and their insurance plans about $4 million a year.
The Clinic can do all of this because of our size of more than 500 providers with a shared commitment to deliver the highest standard of care and control health care costs.
The statewide study offers an opportunity for all in health care to look at where we may be falling short of providing care for our patients.
As patients pay more out-of-pocket for their health care, they are demanding better quality care. They expect that their providers will prescribe appropriate and tangible health solutions.
Rick Cooper is the chief executive officer of The Everett Clinic.
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