Boston Globe - To trim medical costs, apply ‘best practices’ | Friends of Cancer Research

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Boston Globe - To trim medical costs, apply ‘best practices’

FEAR OF intrusion in the doctor-patient relationship so inhibits insurers that they are shunning one of the most obvious ways to cut medical costs: Avoiding costly

 procedures when they are proven to do no good. 

In 2007, the New England Journal of Medicine published an eye-opening study on how doctors could save $5 billion a year by treating patients with chest pain with drugs rather than surgically inserted stents - and since then the study has been largely ignored. The stents vs. medication report is just one example of how researchers have done compelling studies that compare the effectiveness of medical procedures, only to see doctors stick to their old, better-reimbursed ways.

If evidence-based medicine is ever going to reduce health care costs, it will have to be backed up by changes in the way doctors are reimbursed.

The 2007 study followed 2,287 patients with chronic chest pain for five years. It found that using drugs first and inserting stents only if pain persisted was as effective at preventing heart attacks or deaths as inserting stents right away.

The Wall Street Journal recently called attention to another disturbing example of doctors paying no heed to a study pointing the way to more cost-effective care. In 2002, government researchers showed that cheap generic drugs worked as well or better than costly brand-name ones in treating high blood pressure. But that finding made virtually no difference in what doctors prescribed.

The problem is that in most cases neither Medicare nor private insurers give doctors any incentive to opt for a less costly treatment, even if it produces equal or better results. In fact, federal law forbids Medicare from considering the benefits of a treatment when setting reimbursement rates.

Those interested in curbing health costs have to find a way to get doctors to heed the research. Death panels, no. But Medicare should have the authority to weigh both comparative effectiveness and cost in steering doctors to the best practices.

The government should give the medical profession the impetus to determine the most effective treatments for a range of ailments by establishing committees to determine the best practices. Then, if patients seek additional treatments that are clearly ineffective, insurers would be on sound ground in raising objections.

Such best-practice committees are in the stalled health-care legislation in Washington. Even if there is no overhaul of the system, Congress should find a way to fund this inexpensive route to major savings.