Report: Add unnecessary care to doctors’ ‘Do No Harm’ promise

By Eric Tegethoff
Washington News Service

SEATTLE  — In a single year, more than 600,000 Washingtonians underwent treatment they didn’t need, according to a new analysis.

In the Washington Health Alliance report First, Do No Harm: Calculating Health Care Waste in Washington State, researchers found people spent more than $280 million on unnecessary treatments or examinations between July 2015 and June 2016.

The WHA notes three ways this harms patients: physically, emotionally and financially. Report author and WHA Deputy Director Susie Dade says financial harm isn’t talked about as much as the other two, but medical debt is is a major issue. Nationally, nearly one in five Americans has medical debt in collection.

“When they are faced with a decision to pay down debt or send their kids to school or to college, to what kind of housing they can afford — whether they can afford their rent,” she says. “Whether or not they can afford to go to the doctor. Whether or not they can afford to pay for a recommended medications or tests or procedures. All of these things come into play.”

The report analyzed the insurance claims of 1.3 million patients for 47 commonly-overused treatments, which are identified by groups such as the U.S. Preventive Services Task Force. Of those, 11 approaches were most prevalent, including cervical screenings that were too frequent, antibiotic prescriptions, and lab studies prior to low-risk surgeries.

Dade says there isn’t a single reason for the surplus of unneeded care, but a “more is better” approach is pervasive in the health-care system, and both providers and patients fall into this trap. The fee-for-service model that dominates health care also is a factor in overuse.

Dade advises patients to ask five questions about any new procedure or treatment, starting with its necessity, its risks or side-effects, and the possibility of safer options.

“Number four is, ‘What happens if I don’t do anything?'” she suggests. “What happens if I just take a wait-and-see approach for a little while? What are the risks and benefits of doing nothing? And then, finally, ‘How much is this going to cost me and will my insurance pay for it?'”

On the other side, Dade says, providers should look at evidence-based guidance such as the recommendations from the clinician-led “Choosing Wisely” initiative.

She also says tools such as electronic medical records can be used to alert providers when they order a treatment option that isn’t evidence-based.


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