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Wei on Arthritis

The 90

Nathan Wei, MD, Rheumatology, 12:56PM Apr 17, 2013

In a current article Dr. Matthew Mintz relates the anecdote of seeing a patient with diabetes and being informed by the patient that "they" (meaning "Choosing Wisely", a joint effort by the ABIM and Consumer Reports that created a list of 90 overutilized tests, treatments, and procedures) don't recommend treatment for a HgbA1C below a certain level.

He goes on to say, the current fee for service model "creates incentives to physicians for ordering testing and treatment, which is why healthcare spending is out of control."

But then he adds, "a stronger force for ordering tests, etc. is fear of malpractice."

And concludes (sort of) that payers and the government are scrutininizng this group of 90 "overutilized" tests to mandate further cuts in healthcare spending.

One sentence reads... "Given that so many tests and treatments are often overused, it is certainly wise for physicians and patients to scrutinize these practices. However, they should not have to fight with insurance companies or the government to get coverage for something that the physician believes is necessary."

So I wonder, what should physicians do? I'm sure the ABIM and Consumer Reports created this list with good intentions.  In fact, I often use Consumer Reports to help guide my buying decisions when it comes to different products. Sometimes they're right and sometimes not. And the ABIM... I have such fond memories of sitting for the board exams ... not.

While Dr. Mintz's article rightly describes the potential impact of the "gang of 90", he doesn't seem to know what side to come down on. On the one hand he says doctors overutilize... but on the other hand he says in the case of his patient with diabetes, he disagrees with the 90.  I bet there are good docs who will disagree with many and perhaps all of the 90.

So...I say this... when are doctors going to finally say enough is enough?  First we have the government ratcheting down on reimbursements and threatening us with all sorts of RAC worries... then we have the insurance companies denying everything we write for, and then we have the malpractice lawyers sharpening their knives, and then we have the "dreaded" Sunshine Act, then we have the "90" ... and finally an article like this saying... "gee... we better stop overutilizing these tests because we're going to have more things done to us..."

There is no profession I'm aware of that is so tethered by regulations and worries as medicine is now. And quite frankly, we are to blame.  When all this nonsense started we should have had the cajones to say, "Stop it." As it is, we're now reduced to quivering blobs of gelatin that wiggle with pokes from all sides.

Quite frankly, I think the train has left the station.  I'm reminded of the old movie Network, where the protagonist yells out the window "I'm mad as hell and I'm not going to take it anymore."

The sad part is this... even if we all decided to do this now, it wouldn't matter.

About This Blog

Dr. Wei comments on developments in rheumatology... informative, sometimes provocative... sometimes irreverent... and no punches pulled.

Disclosure: Nathan Wei, MD, has disclosed no relevant financial relationships.

  • Nathan Wei

    Nathan Wei, MD, is a graduate of Swarthmore College and the Jefferson Medical College. He completed his residency at the University of Michigan Medical Center in Ann Arbor, Michigan, and his fellowship in arthritis at the National Institutes of Health in Bethesda, Maryland. Dr. Wei is an acknowledged national expert in rheumatoid arthritis and osteoarthritis and is the author of more than 65 publications in the peer reviewed literature. He is a Fellow of the American College of Physicians, a Fellow of the American College of Rheumatology, and is the only American rheumatologist member in the Arthroscopy Association of North America. Dr. Wei is considered an authority and expert in stem cell and platelet-rich plasma (PRP) procedures. He is active in clinical research and is the Director of the Arthritis Treatment Center located in Frederick, Maryland.


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