Overkill an Avalanche of Unnecessary Medical Care

Executive Summary

The topic of low-value care is of great importance in today’s healthcare system based on the recent quest to provide quality and affordable care services. Recent data indicated that low-value care leads to increased administrative and medical care in the healthcare system. According to Gawande (2015), the expenditure on low-value care in the U.S. low-value care exceeds the budget placed for k-12 education. Noticeably, Verkerk et al. (2018) indicated that in 2011 the U.S. government spent approximately $ 389 billion on low-value care. The increased providence of unnecessary care services in the healthcare system leads to a wastage of resources leading to increased care costs. In addition, the victims of low-value care are exposed to the risk of physical, mental, and psychological harm. This is evident through research carried out by (Gawande, 2015) on eight patients. According to the study, seven out of the eight patients had received unnecessary care unrelated to what they were going through or related but could not make them feel better. These results aligned with another study carried out by researchers for one year; their study indicated that 25% to 42% of Medicare patients had received one of the twenty-six useless tests and treatments within that year.

A Summary of the Area(s) Pertinent Course

The three pertinent areas identified are the input facets of healthcare, the output facets of healthcare, and the pressure to reduce healthcare costs. The relationship between healthcare inputs and outputs is one of the most crucial areas presented by the case. According to the case, healthcare inputs involve the salary of healthcare providers and the number of care providers (Gawande, 2015). In contrast, the outputs involve the number of patients attended and the number of surgeries and tests performed. Noticeably, the healthcare inputs and outputs greatly influence the cost; when the inputs are less than the outputs, the inputs and the cost are affected. Patients tend to pay more when the healthcare providers are paid less, affecting healthcare costs and affordability of healthcare services. This is evident in the case of McAllen, where the healthcare providers were paid less, and therefore they used other means to gain more money affecting the type of services given to patients and the total healthcare cost. However, when the inputs are increased, the outputs are reduced due to increased quality, and the cost of care is reduced, increasing affordability. 

Overkill an Avalanche of Unnecessary Medical Care

The definition of Low-Value Care

Low-value care is defined as the care intervention with limited or no benefits to patients, and it is in most cases associated with increased risks and medical costs. In most cases, the victims of low-value care are given treatments and procedures that are unrelated to their conditions or are related but cannot help them. In addition, the victims are exposed to tests and scans that are of no benefit to their medical conditions. These tests may involve CT or MRI scans on low-back pains, yet such procedures are not beneficial in the treatment process. Consequently, low-value care is highly linked with the problem of increased medical costs in the U.S. healthcare system. Gawande (2015) indicated that approximately seven hundred and fifty billion dollars in the U.S. are spent on low-value care. In low-value care, patients are required to receive unnecessary healthcare services and pay for them. In addition, the patients are given treatments and operations that cannot help them, increasing them to a greater risk of harm. 

Why Patients Are Exposed to Low-Value Care

The issue of low-value care is associated with the need to do more in the treatment procedures. The problem of low-value care is associated with an increased need to improve accuracy and validity in the healthcare system. Healthcare providers are always under pressure to ensure that they carry out all the possible tests on a patient to ensure that they treat the specific healthcare problem. Gawande (2015) indicated that in most cases, healthcare providers are more concerned about doing too little rather than doing too much in any care process. This indicates that guilt among healthcare providers stems from the procedures they failed to perform to save a patient rather than the ones they performed in the quest to save as many patients as possible. Therefore, patients are more exposed to the risk of over-testing and over-treatment based on physicians’ need to ensure that all tests are carried out to identify the specific problem. 

The Problem of Overdiagnosis

Over-diagnosis in the healthcare system is a huge problem that can expose patients to great harm. When patients are over-diagnosed, they are given treatments that can expose them to the risk of toxicities. Over-diagnosis involves the diagnosis of abnormalities that cannot cause any harm to a patient. In most cases, the deviations and conditions over-diagnosed would never be the cause of death or morbidity; therefore, treating them cannot help in improving a patient’s prognosis. In most cases, when patients are over-diagnosed, they are over-treated, exposing them to physical, psychological, and emotional harm due to toxicities and labeling. In addition, patients are exposed to a greater financial burden that can affect their ability to afford medical care. 

Rabbits, Birds, and Turtles 

The Rabbits, birds, and turtles ideology is used in describing cancer patients. Gawande (2015) indicated that 75% of all the cancers found in the healthcare system are indolent tumors or turtles with a slow growth rate or stopped growing. Consequently, turtles are indolent tumors with a slow growth rate or are dormant and cannot cause any possible harm to patients. These cancers are common in prostate and breast cancer patients. On the other hand, Emerson, Villalobos & Kaplan (2017) indicated that birds are cancers diagnosed when their tumors have already metastasized and are sometimes beyond treatment, while rabbits are curable tumors that are identified before they metastasize. In most cases, rabbit-like cases are life-threatening, but they are treatable, and therefore early diagnosis and treatment are associated with reduced deaths. Gawande (2015) indicates that turtles, birds, and rabbits appear based on the organ involved. According to the author, it is less likely for colon and cervical cancers to be indolent, and therefore early diagnosis and treatment are always valuable. However, cancers such as prostate are more likely to be indolent, and the treatment of such tumors has increased significantly in the healthcare system. Low-value care in cancer treatment occurs when doctors try to fix turtles that may never cause harm to a patient, therefore, causing more harm than good. An increased introduction of sensitive technologies in the healthcare system has exposed patients to the risk of being treated for cancers that may never cause harm. Sensitive healthcare technologies lead to an increased thoroughness leading to over-diagnosis and over-treatment. 

What Has Happened to the Death Rate from Thyroid Cancer 

Death rates from thyroid cancer have not reduced despite an increased early diagnosis and treatment. Over-testing and over-diagnosis in the healthcare system stem from the notion that early detection of cancers can save lives since it can lead to the identification of tumors before they are dangerously advanced (Gawande, 2015). Therefore, the healthcare system has seen an increased cancer screening for healthy populations leading to a surge in identifying thyroid cancers. However, this increased identification is not associated with reduced death rates from the conditions because, in most cases, the patients are over-diagnosed and therefore given treatments that cause greater harm than good.  

What Happened to Taylor

Tylor suffered from an over-diagnosis. Tylor was a stoic patient who had back issues for a long time. However, one day he threw his back out, and the situation seemed to be extremely serious and worse than other back episodes. Previously, the patient had managed his back problems with stretches and exercises and sometimes by visiting a pain specialist who would administer spinal injections when an attack was bad. After this episode, Tylor visited his primary care physician. It was evident that Tylor had a degenerative disc disease in his lumbar spine after an MRI, and the doctor suggested surgery. However, Tylor was reluctant, and therefore he decided to continue with his stretches and exercises, but there were no improvements. He later went to a surgeon who recommended fusing Taylor’s spine through surgery, but improvements were not guaranteed. Unfortunately, Taylor had no cover, and his salary could not facilitate the treatments. Therefore, he resolved to move to a better hospital (Virginia Mason) under a program by Walmart, and it was identified that the problem had been over-diagnosed, and there was no need for surgery. According to the healthcare providers in Virginia, it is hard to identify back pain-related diseases using imaging, and the Tylor’s symptoms were more related to chronic nerve sensitivity and muscle spasms rather, and they could not be fixed with fusion. After a nonsurgical approach, the patient was cured, and he managed to perform tasks that he could not perform before the treatment. 

The Program’s Name

Such programs are called employer-sponsored medical coverage since Walmart had initiated it for employees undergoing spine, heart, or transplant procedures. In addition, the treatment procedures are known as bundled payments since they cater or specific conditions. 

The Effects of Such Programs on Quality and Cost of Care 

Such programs can reduce medical costs and increase the quality of care in the healthcare system. According to Gawande, Walmart rewards doctors and systems that better ensure that patients get only the necessary care and patients who seek such services (2015). In addition, the company pays on a fixed package price, indicating that doctors are paid at a fixed price despite the procedures they carry. In such situations, physicians are forced to be keen on every procedure to ensure accuracy, therefore providing quality care services (Lee, n.d.). Noticeably, an increased keenness in diagnosis helps reduce the risk of wrong diagnosis or wrong treatments, reducing the risks of recurring medical conditions. Therefore, such programs help reduce the cost of care and increase quality. 

An Alternative 

An alternative to employer-sponsored medical coverage is government-sponsored under Medicare and Medicaid. 

What Happened to McAllen

McAllen had the highest cases of unnecessary care since the care providers had turned into businesspersons. Gawande (2015) opined that per-capita spending in McAllen was more than half of what most individuals in the U.S. spend on healthcare. Medicare patients received almost 40% more surgery and twice as many bladder scopes and heart studies. However, this situation was hinged on the fact that the specialists owned most stakes in the home-healthcare agencies, surgery, and imaging centers. However, the situation was published, and the situation started to change. The practice started to take another approach where quality care was prioritized due to the risk of negative publicity and lawsuits. Gawande (2015) indicated that the changes happened due to the development of an accountable care organization. Physicians were more motivated to provide quality care by ensuring that they would share the benefits and savings accrued from better care. 

How the Inputs to Care Changed

Inputs to care increased since the healthcare providers started to work as teams. Gawande (2015) observed that doctors such as Omar Gomez resolved to build a strong team of care providers around their patients. According to the doctor, he created a team that included specialists such as cardiologists and surgeons, improving patient care. In addition, doctors with more than five thousand or more Medicare patients were registered as accountable-care organizations. Noticeably, this increased the type of care provided to patients, and therefore the inputs increased. 

How the Outputs to Care Changed

The outputs to care changed dramatically after the development of accountable care organizations. Gawande (2015) indicated that there was a 40% reduction in spending on home health services and ambulance rides. In addition, there was a 10% reduction in the number of hospital admissions, tests, and procedures. Therefore, the outputs in McAllen reduced with the development of accountability organizations and regulatory requirements. 

Conclusion

The issue of low-value care is a huge problem in today’s healthcare system. In most cases, patients are given tests and procedures unrelated to their problem or that cannot benefit them in any way. Therefore, it is essential to ensure that the right procedures are developed to ensure that patients receive the necessary care to reduce medical costs and protect them from harm. Over-diagnosis in the healthcare system stems from an increased introduction of advanced technologies that increase accuracy in diagnosis. However, this accuracy can lead to the diagnosis and treatment of turtle diseases exposing patients to the risk of paying more and harm from overtreatment. 

-Low-value care stems from an increased introduction of sensitive healthcare technology

– Over-diagnosis in the healthcare system expose individuals to the risk of receiving treatments that cannot help them or operations that cannot make them feel better.

-Low-value care can be harmful and costly

-The problem can be changed by increasing healthcare inputs, such as better payment plans for healthcare providers.

References

Chalmers, K., Badgery-Parker, T., Pearson, S. A., Brett, J., Scott, I. A., & Elshaug, A. G. (2018). Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data. BMC research notes11(1), 1-8. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-018-3270-4

Emerson, R. W., Villalobos, A., & Kaplan, L. (2017). Basic types of cancer and their biological behavior. Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, 89-101. https://books.google.com/books?hl=en&lr=&id=2qg1DwAAQBAJ&oi=fnd&pg=PA101&dq=rabbits+birds+and+turtles+in+the+healthcare+system&ots=1B9RzThZnP&sig=sb8eTv8UiUTOJa24HISW-QuAiG0

Gawande, A. (2015). Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. The New Yorker.

Lee, R. H. Economics for Healthcare Managers. 4th Edition. 

Verkerk, E. W., Tanke, M. A., Kool, R. B., van Dulmen, S. A., & Westert, G. P. (2018). Limit, lean or listen? A typology of low-value care that gives direction in de-implementation. International Journal for Quality in Health Care30(9), 736-739. https://academic.oup.com/intqhc/article-abstract/30/9/736/4993353

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