National summit looks at overuse of treatments

TJC links with AMA subgroup

More than 200 people gathered in late September to discuss the problem of doing too much for patients. Physicians from the American Medical Association's Physician Consortium for Performance Improvement (PCPI) and The Joint Commission (TJC) held the symposium on overuse of five treatments or procedures:

  • heart vessel stents;
  • blood transfusions;
  • tympanostomy tubes for fluid behind the ear drum;
  • antibiotics prescribed for viral infections such as the common cold;
  • early scheduled birth without medical need.

Along with participants from the two sponsoring organizations, there were other health care professionals, representatives from payer organizations, and patient advocacy groups present at the meeting, says Jerod Loeb, PhD, executive vice president of the division of healthcare quality evaluation at TJC.

He says that there were both believers and non-believers in overuse when the work groups convened to discuss the matter months ago. And even though there is plenty of peer-reviewed information that these practices are widely misused to the detriment of both specific patient health and the overall health of the community, there were dubious attendees at the summit.

"Even when there is consensus, it still happens," says Loeb, recalling a line from one of the speeches given at the summit: One man's overuse is another man's income. "What we need to do is find exemplars out there to help others get religion."

The next step is to put together a white paper that will outline the problem and then come up with potential solutions, Loeb says. For now, he suggests quality managers focus on the topics as a quality and safety issue, not a fiscal one. "Reducing these practices will reduce preventable harm, even if it's hard to see," he says, noting that antibiotic resistance is something we hear about as a public health issue, not in terms of a particular patient being harmed because he or she was given antibiotics when the problem was a simple cold. "We need to create the view that this is a quality improvement problem."

Bernard M. Rosof, MD, chairman of the PCPI, says that physicians need to understand the impact that these unnecessary treatments have in terms of efficiency and cost, too, but that is secondary.

In every case, Rosof says the problem comes down to communication between the patient and the physician and in creating better shared decision-making. "Patients need to ask questions, and physicians need to communicate about why they make certain recommendations to patients and why they don't make others. This takes time, and that's a commodity of value to physicians."

While this particular partnership works on its consensus paper and best practices, there are resources out there that can help physicians do a better job. The American College of Physicians and the American Board of Internal Medicine both have problems related to making good treatment choices and improving patient communication. Share data on early planned deliveries and tympanostomy. Eventually, there may be financial or regulatory repercussions for organizations and physicians that don't get a handle on this, Rosof says. "If you aren't working on this, or don't participate in programs to reduce it and have outliers, I'm sure eventually your payment will be impacted."