It is estimated that about a third of US sick care spending is due to waste or unnecessary medical interventions.
It is estimated that about a third of US sick care spending is due to waste or unnecessary medical interventions. While most of sick care is responding to financial incentives to reduce or eliminate unnecessary hospital readmissions and ER visits, unnecessary outpatient visits continue unabated. They happen for several basic reasons.
1. Legitimate concerns by doctors about follow up issues that are in a grey zone
2. Patients want them for reassurance
3. Doctors have medical liability concerns and thus practice "safe" defensive medicine
4. Doctors don't get paid to do most things that are not done face-to-face in their offices.
5. Doctors don't trust telemedicine and DIY strategies or symptom checker sites
6. Surgeons are used to "routinely" seeing post op patients, when, in many instances, it is unnecessary or can be handled over the phone
7. Some patients play the system to get what they want: drugs, disability payments, or other nefarious motives.
8. Patients are confused by direct to consumer pharma and medtech marketing that tells them to see their doctor.
9. "Routine" check ups, many of which add cost and are worthless, creating unnecessary demand. How about an executive physical or a total body exam for skin cancer?
10. Unscrupulous doctors pad their schedules or, justify it as a way to recoup the costs of all they do for free.
11. Stupid, Kafkaesque prior authorization and approval mandates imposed by payers. Sorry, but you'll have to make an unnecessary appointment to make another unnecessary appointment.
Getting a handle on unnecessary medical visits can have a significant impact on the cost of care. At the same time, we need to balance that with quality of care standards. Technology, rules, reimbursement for non face-to-face administrivia, medical legal reform and doctor and patient education will go a long way to fixing the problem
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