Tuesday, February 14, 2012

Take patients away from the overtreaters

Cross-posted from KevinMD: http://www.kevinmd.com/blog/2012/02/patients-overtreaters.html

A few months ago I was introduced to a gentleman who had been a corporate VP for employee benefits at a Fortune 100 company for many years. I was impressed with his knowledge of health care. He shared some of his experiences with company employees, who lived all over the country.

The company had a policy that when employees were informed they had a very serious medical condition, the company paid for a second opinion.

For example, when employees were told they needed a heart transplant, the company paid the cost for travel and a second opinion at the Mayo Clinic. Mayo found that 40% of the transplants that had been recommended to employees were not medically necessary or appropriate.

The VP saw cases in which transplants were recommended for people who were going to die soon from cancer whether the transplant was done or not.

Sometimes hospitals and surgeons were extremely aggressive in promoting transplants that could not possibly be beneficial to the patients. One hospital recommended a heart-lung transplant for a patient. When the patient visited Mayo for a second opinion, it was discovered that neither a heart nor a lung transplant was indicated for the patient. She left the hospital with no surgery.

Another employee was told he needed a heart transplant. When the VP called the surgeon at a well-known institution to tell him that his company will pay for a Mayo second opinion, the surgeon said the patient shouldn’t fly on a plane in his condition. In fact, the employee has just traveled on a plane to see the surgeon and was happy to go to Mayo for a second opinion. The second opinion revealed a small blockage that was successfully managed with a stent.

The VP said the team in his company that worked with Mayo had a wall of cards and notes from grateful employees. The employees who were spared massive surgeries called the VP’s team members and thanked them over and over again. The employees cried, the team cried, and so did the VP.

I’ve been working on overtreatment for a long time and have written about it in The Treatment Trap but this took my breath away.

The opportunity cost is profound when it comes to transplants. Medically unnecessary transplants take life away from those who could die without a new heart.

So far, the work to shine a light on overtreatment is compelling and includes:

* the “Top Five” list of good practices in primary care that lead to appropriate care, no more and no less, developed by the National Physicians Alliance, funded by the ABIM Foundation, and published in the Archives of Internal Medicine

* the ABIM Foundation’s Choosing Wisely campaign whose message is that wise choices are integral to medical professionalism

We need to get to the high hanging fruit where real and immediate harm is occurring.

As for the former benefits VP, his approach has been to take patients away from the overtreaters. I think Hippocrates would agree this is the right thing to do.

Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation. She is author of The Treatment Trap, Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans, and the forthcoming book, The Battle Over Health Care: What Obama’s Reform Means for America’s Future published by Rowman & Littlefield.

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