Saving Lives, Wasting Money

Cardiologist William Boden, M.D., led the Courage trial, which discovered that stent surgery “usually yields no additional benefit when used with a cocktail of generic drugs in patients suffering from chronic chest pain”.  Dr. Steve Nissen, at the time chairman of the American College of Cardiology, called the Courage findings a “blockbuster,” but the Wall Street Journal quotes Dr. Boden as saying: “Most (cardiologists) haven’t voluntarily incorporated the Courage criteria into their practice. What’s going to continue to drive practice is reimbursement.” The Journal article also cites Dr. Sanjay Kaul of Cedars-Sinai Heart Institute in Los Angeles, who argued that the U.S. healthcare system could save $5 billion of the $15 billion it spends annually on stent procedures if it adopted the Courage guidelines.
The Courage trial, “medicine’s missed opportunity for comparative effective savings,” is mirrored by a recent study that determined the 2005 decision by Medicare to pay doctors to do bladder surgery in their offices “dramatically raised the number of procedures and overall health costs”.
In short, the current U.S. healthcare system rewards doctors for overusing expensive procedures. Like the FDA, the system must be reformed from the ground up. Lori Knutson, R.N., BC-HN, executive director of the Penny George Institute, reports that inpatient integrative care is saving $2,000 per patient per hospital stay at Abbott Northwestern Hospital. What a great model to study!