… grudgingly admit that the reason they order all the extra tests and procedures is NOT CYA, but that they make more money doing so.

I’m imputing physician’s mental constructs when I say physicians will “know” they have to order tests for CYA purposes. I believe that doctors want to feel they act altruistically, knowing that profit is driving their decisions is a hard lesson to internalize. I think that for profit doctors will fall back on disproved rationales for their behavior so they can feel good about that behavior.

I’m not saying it (the rationale) is legitimate, just that I see it as something to overcome.

The Mayo model uses team case review to arrive at healthy outcomes at lower costs. If a test isn’t needed other physicians speak up and reduce the waste. Peer esteem is a good motivator, the crux is getting peers that are concerned with healthy outcomes at low cost. In McAllen it seems that peer physicians value profit most.

But that’s not something they “know,” it’s an excuse for their own bad behavior. Eliminating the threat of litigation doesn’t cause them to stop ordering extra tests. There is some old data taken with very limited sampling that argues physicians in “unreformed” states order more procedures than those that don’t, but there is other, more recent data that refutes that, and shows there is no reliable correlation between state tort law and physician practices.

When physicians are surveyed they often claim that X percent of their tests are ordered for CYA purposes, but their actual behavior doesn’t bear that out. And this is an important point, because the “defensive medicine” myth is a major part of the Right’s argument that (1) health care can be “reformed” and remain private and for-profit; and (2) personal injury litigation in general is bad for business and needs to be stopped, 7th Amendment be damned. It’s very important not to give these arguments legitimacy.

There’s a website maintained by Americans for Insurance Reform that has some good information and is worth checking out –

http://www.insurance-reform.org/issues/index.html

Changing the (profit) incentives for added tests is needed. I’m not very sanguine about change happening fast, I think that absent incentives to order extra tests there still will be cultural inertia to order them, as well as the aforementioned internalized CYA message.

BTW, thanks for engaging on this. That article helped me go from half baked ideas about where the problem lies into a somewhat deeper understanding. Obviously. The message that the Mayo clinic delivers higher quality care at a lower cost, why can’t we restructure health care more towards their model is a winner (and Obama picked up on it). It is worth repeating – the Mayo clinic has a deservedly good reputation and the surprise that they are low cost can help overcome the sense that health care is politically intractable.

The author points this out, and the doctors admit that malpractice litigation has dropped to just about zero. Then the doctors grudgingly admit that the reason they order all the extra tests and procedures is NOT CYA, but that they make more money doing so.

And from there the author goes on to make the case that not-for-profit hospitals and medical groups tend to have both lower costs and better outcomes, and this is in part because physicians either get no extra income from ordering extra stuff, or else the local medical community actively discourages ordering extra stuff.

It’s also worth noting that in the past 20 years or so more than half of the states have enacted some kind of tort reform to curtail malpractice and other personal injury lawsuits and cap the amount of damages juries can award. The cost of health care is not affected at all by these measures. The cost of health care continues to increase at the same rates as in non-tort reform states. In the case of Texas, it has increased faster

We need to get over the idea that malpractice litigation is a factor in rising cost of health care.

Can I get a !!!!

If we could get more clinics using the Mayo/Grand Junction processes… a lot of cost could be driven out of the system. Of course wingnuts will talk about government interference in the practice of medicine.

I duplicated the link – I think the article is well worth commending to a wide audience. (h/t baseline scenario)