The Users' Guide to the Health Reform Galaxy

'Bending the Cost Curve' by Tackling Overuse of Diagnostic Imaging

Bruce Siegel, director of the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative and the RWJF legacy program, Expecting Success: Excellence in Cardiac Care, examines how some communities are using evidence-based  guidelines to rein in a conspicuous source of health care overspending. This post is part of our continuing effort to shine a light on local laboratories of health care reform.

If you look closely in Aligning Forces for Quality communities, you can see how local laboratories are grappling with some of the most vexing delivery issues in health care. And there is probably no more vexing issue than overuse of health services—an issue that has figured prominently in the health care debate as Congress and the president wrestled with the question of how best to control costs.

Dartmouth researchers have estimated that as much as 30 percent of health care spending is for care that doesn’t improve people’s health—and don’t just take their word for it. Thompson Reuters came out with a new study last October attesting to the reasonableness of this estimate.

Diagnostic imaging, especially when it involves lower-back pain, is one case drawing the attention of overuse detectives. Lower-back pain is the fifth-most-common reason Americans see a doctor, and the common use of expensive imaging technology to diagnose it has become controversial. For more than a decade, guidelines for treating lower-back pain have recommend delaying imaging use for most patients because their backs typically get better, and their pain often subsides, within a month. A recent study published in Health Affairs took a look at the relationship between the supply of MRI machines, and their use for lower-back pain. Surprise, surprise: The researchers found “a clear relationship between MRI availability and MRI use for low back pain patients.”

The path between the rock and the hard place

Arnold Milstein writes about the unnecessarily hard choice impeding health reform.  The views he expresses here do not represent those of any organizations with which he is affiliated.

Some Congressional observers are gloomy about the prospects for health reform legislation that could get most people covered. Bedeviling the current political debate is a belief that a “pay-go” Congress committed to debt control must make a choice between extending expanded health insurance coverage and avoiding unpopular tax increases or indiscriminate Medicare fee cuts.

The perception of an inescapable trade-off is flawed: there is a technically achievable and politically viable path between the rock and the hard place.  That path is incentivizing greater efficiency in how we deliver care without sacrificing quality improvement or biomedical innovation.