Primary Care Docs Urged to Cut Care Not 'Medically Beneficial'

From Medpage Today:

Doctors need to stop providing medical services that are unlikely to help patients but add significant costs, the CEO of a major association of primary care physicians urged at an event focused on saving money and improving patient care sponsored by Health Affairs.

“We must ask physicians to cut back costs, there is absolutely no question about that,” said Steven Weinberger, MD, executive vice president and CEO of the American College of Physicians.

If doctors stopped doing just seven things, it would save about $5 billion annually in healthcare costs, said Nancy Morioka-Douglas, MD, of Stanford University — $4 billion alone from prescribing generic cholesterol-lowering drugs.

Morioka-Douglas went on to list the seven things primary care doctors commonly do for patients that aren’t medically beneficial and add significant expense to the healthcare system:

1. Using imaging in patients who have had low back pain for fewer than six weeks. Low back pain is the fifth most common reason that patients visit a primary care doctors, Morioka-Douglas said, adding, “Imaging before six weeks doesn’t improve outcomes, but it does increase costs.”
2. Giving antibiotics for sinusitis. Sinus pain accounts for 16 million office visits each year and $5.8 billion in annual healthcare costs. The underlying cause is generally a virus — not a bacteria — which will likely resolve on its own, yet 80% of office visits in sinusitis end with a prescription for antibiotics, Morioka-Douglas said. Moreover, overuse of antibiotics can lead to antibiotic resistance.
3. Ordering an electrocardiogram (ECG) or other cardiac screening for low-risk patients.
4.  Performing a Pap test in women who’ve had total hysterectomy for benign disease. Pap tests on women who no longer have a cervix are not clinically beneficial, yet they still occur in doctors’ offices, Morioka-Douglas said.
5. Ordering bone density scans for women under the age of 65, or men under 70, who have no risk factors.
6. Prescribing brand-name statins such as Lipitor instead of generics.Doctors should always start with generic statins, and only switch to a brand-name drug if there’s an adverse reaction or if the patient doesn’t achieve LDL goals, Morioka-Douglas said.
7. Obtaining a blood chemistry panel or urinalysis for asymptomatic, healthy adult patients. However, added Morioka-Douglas, asymptomatic adults with hypertension should be screened for type 2 diabetes.

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