Author Rosemarie Gibson with members of HCFA’s Consumer Health Quality Council
Rosemary Gibson, a nationally-known expert on health care quality issues, spoke yesterday at Health Care For All about her new book, “The Treatment Trap,” which focuses on overuse of medical care. Both this new book and Ms. Gibson’s first book, “Wall of Silence,” seek to shine light on aspects of the health care system that often do not get much attention among the general public. She shines this light by telling personal stories of individuals and families impacted by medical errors (in “Wall of Silence”) and by overuse of medical care (in “Treatment Trap”).
The Institute of Medicine defines overuse as when “the potential for harm of a health care service exceeds the possible benefit.” During her talk, Ms. Gibson spoke of how advocacy efforts by individuals and organizations passionate about reducing medical errors has led to legislation in many states (including MA) requiring public reporting of infections and Serious Reportable Events. She believes a similar type of advocacy effort should start to look at the epidemic of overuse of care. And she also believes that there should be public reporting of provider outliers when it comes to rates of procedures so that the public and policymakers, and providers themselves, can determine what is leading to those high rates of use.
Ms. Gibson talked about particular areas in which there has been evidence of overuse, such as CT scans, hysterectomies, use of ear tubes in children, spine surgeries, and heart bypass surgeries, among other areas, and she discussed the variations in levels of procedures that are seen across communities, as has been revealed by researchers at Dartmouth. She talked about the need to educate everyone, including consumers, about problems relating to overuse, and she talked about the barriers to effectively delivering messages about overuse, including the belief that more medical care is always better.
She used a traffic light metaphor as a way to communicate to consumers: a green light is for procedures that you should always have done like an appendectomy for a burst appendix; a yellow light is for something that should be discussed between a patient and provider to decide together if the procedure should be done, like deciding if a woman in her 40s should have a mammogram every year based on medical history, risks and benefits, etc.; and a red light is for treatment you don’t want to get because the potential for harm exceeds the potential benefit. She also spoke about moving from informed consent (in which you are agreeing to a treatment plan decided upon by someone else) to informed choice through the use of decision aids, as is done in the shared decision making model. She described this as a powerful way to engage consumers and bring about patient-provider discussions when deciding on care and she encouraged creative thinking by all stakeholders as to how to encourage the use of decision aids (such as insurance companies waiving co-pays if members use on-line decision aids, or providing decision aids to members of the public at no charge).
Ms. Gibson closed by asking what Massachusetts can look to do towards reducing overuse of care. She noted the work being done by the Attorney General’s Office and the Division of Health Care Finance and Policyto examine cost drivers, and she suggested that overuse be looked at more closely as part of this work. Ms. Gibson also talked about the work being done at the federal level on Comparative Effectiveness Research (CER), which compares different treatments for the same condition and determines which treatments are most effective and which are ineffective or even harmful.
She is concerned that there will be information out there for both providers and patients but that it may not actually be used to reduce overuse, especially, from the patient side, if the information is not effectively translated into consumer tools for patient decision making. Perhaps Massachusetts policymakers can play a role in making sure CER materials are developed for use by residents of the Commonwealth in addition to finding a way for already-developed decision aids to be used more. Massachusetts could also look to ensure that the CER work is made available to, and utilized by, providers and to find a way for providers across the Commonwealth to share what they learn about effectiveness of procedures so that all providers can practice evidence-based medicine, thus reducing the use of care that harms consumers and the health care system.
If you have a story of overuse that you would like to share, please contact Deb Wachenheim at firstname.lastname@example.org.