The Choosing Wisely campaign: back off on 45 diagnostic tests

Doctors Urge Their Colleagues To Quit Doing Worthless Tests
April 04, 2012
http://www.npr.org/blogs/health/2012/04/04/149978690/doctors-urge-their-colleagues-to-quit-doing-worthless-tests

Nine national medical groups are launching a campaign called Choosing Wisely http://www.choosingwisely.org to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays.
Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

And here’s one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn’t get more chemotherapy.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

“That’s certainly the number we use,” Dr. Steven Weinberger, CEO of the American College of Physicians, tells Shots. “Most of us feel something like $750 billion or so could be eliminated from the system out of the $2.5 trillion or so that we spend on health care.”

Weinberger says unneeded diagnostic tests probably account for $250 billion.

Proponents of the campaign are aware they’re wading into dangerous waters.
“There will be some … that may demonize this campaign and infer the R-word — rationing,” Daniel Wolfson of the ABIM Foundation wrote in December when the campaign was launched.

But rationing is the denial of care that patients need, Wolfson points out.
The Choosing Wisely campaign aims to reduce care that has no value.

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The average family would never know how to do

Kids With Costly Medical Issues Get Help, But Not Enough
August 26, 2013
http://www.npr.org/blogs/health/2013/08/26/214852775/kids-with-costly-medical-issues-get-help-but-not-enough

“Katie hit a million [dollars] in her first year of life,” says Marcy Doderer, Katie’s mother. Katie used to require 24-hour nursing; now the nurse only comes at night, but it still costs almost $75,000 a year, by Marcy’s estimate. It’s a service that most private insurance doesn’t cover. It is, however, paid for by Katie’s Medicaid coverage—even though the family is well off.

Marcy Doderer, who until recently was the CEO of the children’s hospital in San Antonio, Texas, acknowledges that her job gives her family an advantage. “I know how to navigate the system,” she says. “I know how to find ways to get what my child needs that the average family would never know how to do.”

“It’s important to think about health care spending not as competing for infinite dollars where everyone gets everything they want,” says Salo. “Health care is, unfortunately, a limited pool of funds. So carving out additional dollars for one group may well mean that another group gets less—low-income frail seniors or individuals with physical disabilities.”

rationing

related:
http://www.npr.org/blogs/health/2015/03/27/395586203/medical-bills-linger-long-after-cancer-treatment-ends

http://www.npr.org/sections/health-shots/2016/03/08/468892489/medical-bills-still-take-a-big-toll-even-with-insurance

‘Not Fighting For Just Sarah’: Rating Transplant Priorities

‘Not Fighting For Just Sarah’: Rating Transplant Priorities
June 08, 2013
http://www.npr.org/2013/06/08/189861416/not-fighting-for-just-sarah-rating-transplant-priorities

the fairness of organ transplant

a Pennsylvania girl who is dying from cystic fibrosis

The first thing to note is that there just aren’t enough organs available.
More than 100,000 people are on the list for a new organ, according to the Organ Procurement and Transplantation Network, a nonprofit contracted by the federal government to regulate transplants in the U.S.
And 18 die each day while still waiting.

“What isn’t a good situation is admission to the transplant centers. One of the first tests that everybody does is a very thorough wallet biopsy,” he says. “So the ability to pay counts. … It’s a major driver in access to transplants.”

He says Medicaid will cover transplantation for low-income patients, but not in every state.
Transplants easily run hundreds of thousands of dollars, some even hitting seven figures.

Roberts says it’s the post-surgery costs that can create the biggest financial hurdle for patients.
“The medications are lifelong, and they are expensive,” he says.

*her gain is someone else’s loss

*rationing

related:
http://www.npr.org/2015/05/01/403303311/for-man-with-cystic-fibrosis-death-is-like-a-deadline

Aaron Glantz

Veterans Face Red Tape Accessing Disability, Other Benefits
Aaron Glantz
March 18, 2013
http://www.npr.org/2013/03/19/174639343/veterans-face-red-tape-accessing-disability-other-benefits

Last year the VA inspector general found that the average wait time for a mental health appointment was 50 days. … This is not because of a [malicious] intent; this is because the resources are being rationed because there are not enough providers.

Dr. Peter J. N. Linnerooth, 1970–2013
http://nation.time.com/2013/01/11/dr-peter-j-n-linnerooth-1970-2013
PTSD

==================

http://www.nytimes.com/2014/08/04/opinion/adventures-in-prior-authorization.html

http://www.northcountrypublicradio.org/news/story/27142/20150109/why-a-veterans-mental-health-bill-is-stuck-in-congress

Writing Project Helps Veterans Heal Wounds
January 27, 2008
http://www.npr.org/templates/story/story.php?storyId=18456174

US healthcare expenditure as a percentage of GDP 1960-2013
http://dupress.com/articles/current-trends-in-health-care-new-landscape-obamacare