You Can’t Afford Low-Quality Health Care

The problem of misdiagnosis is particularly relevant in spine care because, relative to national averages, high-quality care can yield vastly improved patient outcomes and huge cost savings. Unnecessary spinal surgery is the epitome of low-quality care.

And yet, as reported by Harvard professor and surgeon Atul Gawande in The New Yorker, “doctors [at national centers of excellence for spine care] are finding that around 30% of the spinal procedures that employees were told they needed are inappropriate” and therefore not performed.

That finding alone means thousands of employees would have undergone expensive, unnecessary surgeries, risking complications and racking up significant workers’ compensation bills during their recoveries, had they not gotten a high-quality second opinion before it was too late.

Cutting health care costs doesn’t mean looking for the lowest-priced surgeon for your employee. It means finding the best surgeon—and then making sure your employee needs the surgery in the first place.

Walmart, for one, is doing exactly that. In his New Yorker piece, Gawande describes how one Walmart employee was flown to Seattle for a spinal fusion that the doctors at the world-class Virginia Mason Medical Center decided he didn’t need. Instead, they gave him a simple injection and sent him home, where he made a full recovery.

For that patient, getting the right diagnosis made all the difference. And for Walmart, it saved thousands of dollars in surgical costs and workers’ comp payments.

High-quality diagnostics thus help to avoid unnecessary care. It seems counterintuitive to say that you can’t afford low-quality care. But the truth is that low-quality care is a bad deal at any price.

In contrast, given the demonstrated prevalence of diagnostic errors and the cascading impact of incorrect diagnoses, the return on investment for high-quality care—and high-quality diagnostics, in particular—has proven compelling.

By steering patients toward providers who have demonstrated the ability to arrive at more accurate diagnoses, we improve the chances those patients will receive all of the care they need—and none of the care they don’t, which we’ve found can save up to 35% on total claim costs.

That figure serves as proof of concept, corroborating the value of focusing on quality over price when seeking to cut health care costs.

Gawande argues that unnecessary care stems from misaligned incentives. Doctors often make more for doing more, he says, whether it’s necessary or not. They may not be specialists in the diagnosis and treatment of any given condition. And they may fear the consequences of inaction—health consequences for the patient, legal and financial consequences for themselves.

But those misaligned incentives have created financial consequences that ripple through our entire health care system. Health care spending has gotten out of control even as the quality of the care we receive remains suboptimal. To fix our broken system, improving quality even as we control spending, we have to start by insisting on high-quality care—and refusing to pay for anything less.

When the alternative is costs that continue to rise with no corresponding improvement in outcomes, we really can’t afford to do anything else.

— Read Hospitals That Mess Up Are Urged to Confess on ThinkAdvisor.