Clinical Procedures likely to have little to no benefit are still being performed in Australian hospitals. Not only wasting resources like bed days that could be freed up for more needy patients; But also taxpayers dollars in the million.
A landmark study led by professor Adam Elshaug of the Menzies Centre for Health Policy at the University of Sydney has drawn attention to the high number of low-value procedures and significant variation between hospitals in NSW alone.
‘The Study examined rates of 27 questionable procedures in 2016 & 2017. The study coincided with the launch of campaigns such as Choosing Wisely and the Royal Australasian College of Physicians’ EVOLVE initiative, where professionals in the industry had advocated best practice in the form of ‘Do Not Do’ policies. While 13 of those procedures were performed at negligible levels — a positive result — the remaining 14 procedures were found to have been performed more often and with starkly contrasting trends: seven have decreased, four have remained steady, and three have increased.’ – The Australian
So what are the Procedures that are Low-Value?
The Department of Health and Ageing asked researchers to create a list of existing Medicare Benefits Schedule (MBS) procedures and tests that are ineffective, unsafe or used inappropriately. The procedures are as follows:
- Arthroscopic surgery for knee osteoarthritis – The outcomes of the procedure devalue the amount of work that needs to be done to justify the cost. the outcomes are no better than placebo surgery or physical therapy and medication.
- Vertebroplasty for osteoporotic spinal fractures – The procedure is highly intrusive, plastic cement is injected into spinal fractures caused by osteoporosis. This again is as good as a placebo procedure and actually increases risk in future fractures.
- Chlamydia screening – Screening the general population ever so often for Chlamydia has no effect on the outcome of the disease in itself.
- Imaging – Various forms of medical imaging – such as X-rays, CT scans, ultrasound and MRI – have been found to have no additional benefit to other diagnostic procedures in certain situations. Excessive exposure to some forms of imaging, such as CT scans and X-rays, may be harmful, and they can also be costly.
- Prostate Specific Antigen (PSA) testing – Men aged 75-80 with PSA levels below a certain amount have a very low chance of suffering from aggressive prostate cancer which dismisses the benefits of PSA testing.
- Surgery for obstructive sleep apnoea (OSA) – there are plenty of lifestyle changes that could help with sleep apnoea, research shows there is very low positive impact with surgery. There are more risks involved than there are benefits.
- Adenoidectomy for children – Removal of adenoids is performed on children with chronic nasal infection symptoms, such as runny nose or obstruction, however there’s no evidence it helps.
So why are these procedures still performed?
Why would doctors schedule tests that yield low outcomes for their patients? . A study of Victorian hospitals found that despite mounting evidence over 10 years that arthroscopic procedures for osteoarthritis of the knee is of questionable benefit, its use over this time didn’t decrease, and actually increased for certain groups.
Placebo surgery often works for the short term, it provides the patient with short term relief, but negligent effects in the long term.
How does this Affect OOP?
With placebo procedures the patients are the ones that are paying the price, it’s financially toxic as they pay for something that is often only a short term fix. This degrades the quality and the care factor that the hospital is trying to provide.
Learn from Industry Leaders like Dr. Stephen Duckett on how you can add value to your customers and how to effectively use hospital resources at the Financial & Operational Improvement in Hospitals, 23rd & 24th October 2018, Sydney