Defining healthcare waste: The official in charge of Medicare and Medicaid speaks out

When it comes to a sensitive issue like healthcare, it is quite difficult to differentiate the waste from the necessary. Part of the problem is that people have been taught from an early age that all the stuff we are supposed to do for our health is indeed necessary and without it, we will surely meet our demise. This has increased our dependence on a healthcare system that more often than not, under delivers while charging a fortune for services driven more by fear than by actually delivering a health benefit. We read all the time about the drug that has been taken off the market, the procedure that is no longer done because of side effects or because it has been found that it had no benefit or made the problem worse (arthroscopy for the arthritic knee comes to mind). In the practice of musculoskeletal medicine, during the 1990's, insurance companies had begun to hire companies who would limit the amount of care they would authorize for chiropractic patients and increase the paperwork doctors needed to do. The increased scrutiny saved them money, while making it more difficult for doctors to help them. Many chiropractors learned how to treat more efficiently using methods such as Active Release Techniques or Graston Technique. In our practice, we begun to use these methods and developed our own proprietary methods of active evaluation, a diagnostic method that by its nature of test, treat, retest cut costs and improved outcomes, when compared to the older static model of diagnose, treat a bunch of sessions and then reevaluate. This allowed us to get people better faster, and more reliably with much higher levels of satisfaction and effectiveness. Some physical therapists were subjected to the same thing, however more often than not, chiropractors were more highly scrutinized. The effect was that chiropractic for those who changed became much more effective when compared to most physical therapists because they had to for survival. When looking at the subject of waste, I often wondered why the person with the broken shoulder who had six months of continuous rehab still had restrictions which our office would have likely resolved in usually 10-15 visits. This is surely wasteful and is commonplace. Other things such as the PSA test are now being questioned, and older patients are now being advised not to have this test because it led to unnecessary and harmful interventions worse than the prostate problem it was trying to solve. Read the NY Times article here The bottom line in my opinion is that we need to reeducate the public about when doctors are truly necessary. In the skeletal system, there is this idea that things work themselves out. If you are having symptoms from mechanical issues, mechanical issues do not work themselves out and you need to see us eventually. Do you really need cholesterol meds or bone forming medications or have you been led to believe you need them because of the fear of having a health problem? The truth is we eventually will meet our own demise somehow, and although we can delay it with today's healthcare systems, we need to know when it is appropriate to use that technology, which has been made expensive by design to extend life, vs. when it is clearly inappropriate because it does not change the inevitable outcome. These types of interventions usually end the same way, with bills for tests and such that are not helpful or appropriate, surgeries in the last week of life and bills for care that extended the misery of dying. Disney said this well in their Lion King Great Circle of Life analogy. We just need to learn to accept it. Let me know what you think? As always, I value your opinion.