What you need to know about a Washington State report on health care waste

ProPublica reporter Marshall Allen opens his article about a Washington State report on unnecessary medical care like this:

It’s one of the intractable financial boondoggles of the U.S. health care system: Lots and lots of patients get lots and lots of tests and procedures they don’t need.

The authors from the Washington Health Alliance who published “First, Do No Harm: Calculating Health Care Waste in Washington State,” open their report like this:

Harm to patients can come in multiple forms. While harm is not intentional, it is particularly troublesome when it is a result of care that was unnecessary in the first place.

The same is true of health care journalism that contributes to this harm. While reporters don’t intend to cause harm, it’s particularly troublesome when it is the result of reporting that was not comprehensive and skeptical enough in the first place.

How often do we see reporting that hypes or promotes screening that is not evidence-based? A lot.

Journalists shouldn’t take their audiences down the path of unnecessary tests

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The report does well in reminding us that beyond physical harms, there are usually inevitable emotional and financial harms that come into play. Stop and consider what a falsely positive test for cancer might feel like. Maybe you, or someone you know, is among the 45 percent of Americans who say they would struggle to cover an unexpected $500 medical bill.

Reporter Allen’s article — which was carried by both NPR and Kaiser Health News — speculates on what might be driving such alarming overuse and waste. One contributing factor is brought up by H. Gilbert Welch, MD of the Dartmouth Institute:

The medical system is still dominated by a payment system that pays providers for doing tests and procedures. Incentives matter … as long as people are paid more to do more, they will tend to do too much.

There are other factors to consider. How often do we as patients insist our doctors do something? Maybe prescribe something? And what role do doctors play? We know of their time constraints — and some providers do order things ‘just to be sure,’ or to avoid a lawsuit — but what about this emerging trend of offering financial incentives based on their patient satisfaction scores? Could this lead to ordering tests, or prescribing medicines, simply to curry favor and, therefore, increase income?

These are just a handful of many questions raised by this report. A report that speaks to a malignancy in our health care system that is clearly metastatic and untreated.