Unbiased Analysis of Today's Healthcare Issues

Too much care? The case of cardiology in Elyria

Written By: Jason Shafrin - Aug• 26•06

The New York Times last week wrote an article (“…off the charts…“) examining the use of invasive treatment for cardiac problems in Elyria, Ohio.  The article says that this small city has angioplasty rates which are significantly higher than any other U.S. city.

“…outside experts say such a locally dominant cardiology group could make it hard for patients to be aware of other treatment options. They also say there is no clear medical reason for so many patients in Elyria to be so much more likely than heart patients elsewhere to require angioplasty.”

On the other hand, Kaiser Permanente’s salaried doctors in Ohio have an incentive minimize care:

” ‘It’s not just individual doctors making up their minds,’ explained Dr. Ronald L. Copeland, the executive medical director for Kaiser’s medical group in Ohio. With no financial reason to perform expensive procedures, the Kaiser doctors frequently choose to manage the patients’ heart disease with drugs only. ‘Our doctors have no disincentive to do that,’ Dr. Copeland said.”

It is important for healthcare consumers to realize that doctors respond to financial incentives just like the rest of us.

“…some outside experts say they are concerned that Elyria is an example, albeit an extreme one, of how medical decisions in this country can be influenced by financial incentives and professional training more than by solid evidence of what works best for a particular patient.”

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  1. BC says:

    This is a classic example of why large payers need sophisticated software to identify these expensive variances in practice patterns that are not producing any meaningful improvement in either quality of life or longevity. The goal should be to bring about as much convergence with the most cost-effective practice patterns as possible.

    For Medicare (and/or Medicaid) to just blindly and mechanically pay this bills with little or no oversignt is an outrage. With fraud also a significant but difficult to quantify problem, I find it hard to understand why so many people seem to want Medicare to insure everyone. The low administrative costs that they love to brag about seem greatly overwhelmed by overtreating, fraud and unnecessary care. Let’s not be too quick to squeeze private insurers out of the healthcare system in the future.

  2. […] Joe Paduda of Managed Care Matters did some research and found that a cardiology department in Elyria, Ohio received an award for quality (”Quality means exactly what?“).  Why is this significant?  As I noted on Saturday, this same department performed four times as many angioplasties as the rest of the country.  Mr. Paduda sums up the problems with quality measurement well: “…the center had “the lowest complication rate”. That could be because the cardiologists are really great. Or it could be because they perform a lot of procedures on low risk patients , patients that are likely to require relatively short lengths of stay and experience low complication rates.” […]