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Dr. Butterly: Tell patients this will hurt

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Dr. John Butterly recently urged insurance regulators in New Hampshire to recognize the importance of reducing the entire cost of care for an entire patient and an entire population of patients.

Too often, Butterly said, policymakers get distracted by the cost of a unit of care, such as the cost of an office visit or the cost of a cardiac catheterization.

“Unit cost really isn’t the issue,” Butterly said. “It really is about the total cost…. That’s clearly the metric for population health management.”

Today, however, patients usually can’t make decisions based on the likely total cost of their care, because total medical expense costs are even harder for patients to get than unit costs, Butterly said.

Butterly spoke in September at a hearing on health insurance rates that was organized by the New Hampshire Insurance Department.

Butterly, a cardiologist, is the executive medical director at Dartmouth-Hitchcock Medical Center.

The New Hampshire department has posted a hearing transcript on its website.

Butterly said he believes that he is much less likely to recommend cardiac catheterization than another cardiologist.

The unit cost will be higher, and the total cost of care for the patient catheterized could be either higher or lower, but the total cost of care for the patient population will be lower because of the low use of the procedure for that group of patients, Butterly said.

Dartmouth-Hitchock has always been low at using expensive medical interventions, but, today, because total medical expense figures are not reported in the same way as unit costs, total medical expense figures are much harder to find on the Internet, Butterly said.

Butterly also talked generally about policymakers’ approach to health care cost reform.

“One of the things that I see is that people are trying very, very hard to minimize the pain that I think we know is coming,” Butterly said. “One of the first lessons I learned in medical school was that, when you’re going to recommend something to a patient or you’re going to do something to a patient and it’s going to hurt, do not tell them, ‘It isn’t going to hurt.’ And, this is going to hurt.”

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