Spotlighting 5 medical treatments that may be overused

In 2011, the Institute of Medicine released a report that had some shocking conclusions. A whopping $765 billion in 2009 health system spending was deemed to have been wasted, with a large portion of that amount — $210 billion — linked to unnecessary services.

Overuse of medical interventions and treatments that provide no benefit to patients is not only costly, it also can be dangerous. For example, an estimated $1 billion is spent each year on unnecessary antibiotics prescribed to treat viral upper respiratory infections in adults. Research shows that using antibiotics for these infections is not effective and can harm patients. Overusing antibiotics builds resistance to these drugs and can trigger allergic reactions and problems with other medications.

Why is there so much spending on unneeded tests and treatments? It’s a complex issue that has multiple causes among multiple players. Quality care experts, for example, say some doctors may be responding to patients who demand antibiotics or certain other treatments. Time pressures on medical practices, liability concerns and payment incentives tied to service volume also can tip the scales toward more interventions rather than fewer.

But identifying the possible causes and doing something meaningful to address them are very different. That’s why physicians and others in the medical community are working together to make sure that patients get all the care they need without also getting unnecessary tests and treatments.

Two organizations seeking solutions are the American Medical Association-Convened Physician Consortium for Performance Improvement and the Joint Commission. They co-sponsored the National Summit on Overuse in September 2012 in Chicago to examine research and develop strategies on five treatments on which there is some consensus that they are commonly overused. The summit brought together representatives from 112 physician organizations, government agencies, research institutions and other groups.

The five treatments that went under their microscope are: use of antibiotics for viral upper respiratory infections; over-transfusion of red blood cells; tympanostomy tubes for middle ear effusion for brief periods; early scheduled births without medical need; and elective percutaneous coronary intervention.

Advisory panels developed recommendations that should help determine the appropriate use of the treatments while reducing potential risks to patients. In July, the PCPI and the Joint Commission released a report on the summit and its findings. The PCPI also has developed physician performance measures that address concerns about overuse.

The new report spells out some solutions that should be of great help for doctors considering the five treatments. Concerning viral upper respiratory infections, the paper recommends developing clinically relevant definitions of viral and bacterial URIs. Current guidance for doctors can be contradictory, so the report calls for aligning current national guidelines for such infections. Other recommendations include launching a national education campaign on overuse of antibiotics and partnering with the Centers for Disease Control and Prevention on the issue.

The report notes that inappropriate blood management interventions can contribute to unnecessary transfusions. Part of the problem is that there is not enough education on transfusion medicine in medical school or during residency. So the groups at the summit called for creating a toolkit of clinical education materials for physicians and expanding education on transfusion avoidance and appropriate alternatives. Recommendations on elective percutaneous coronary intervention include focusing on informed consent and promoting patient understanding of the risks and benefits of PCI, as well as encouraging standardized reporting in catheterization and interventional procedures reports.

The July report is the latest installment in medicine’s committed effort to do the right thing for patients. In April 2012, for example, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign to get doctors and patients talking about medical tests and procedures that may not be needed in some circumstances. The initial list of 45 interventions to scrutinize grew to 135 earlier this year, addressing areas such as stress tests in low-risk asymptomatic patients and routine annual Pap smears. The potential for improvement is great because more than 35 specialty societies representing about 500,000 physicians have joined the campaign.

These efforts are necessary steps toward eliminating unnecessary treatments. When medical professionals, patients and policymakers get on the same page and make overused interventions a thing of the past, everyone will benefit.