It's a common challenge: funding new and expensive treatments, with increasing pressure on budgets, harmful deficit spending, and ever-higher health insurance premiums. One solution to these concerns is to scale back on outdated or low-value procedures.
Yet scaling-back expensive medical treatments for certain medical practices is a bit complicated.
To better understand the process, researchers at The Dartmouth Institute for Health Policy and Clinical Practice studied nearly 10,000 physicians who performed carotid revascularization -- a surgical procedure used to reduce the risk of stroke by correcting narrowing in the carotid artery -- on elderly Medicare patients between 2006-2013. Its use is increasingly controversial, particularly among older patients and for those who aren't exhibiting symptoms of carotid artery narrowing.
In the study, recently published in the BMJ, the researchers found a declining trend in the rate of carotid revascularization nationally from 2006 to 2013, which is consistent with other evidence.
Yet the decline was by no means consistent across different types of physicians; those with more than 25 years of experience were likely to cut back on their use of carotid revascularization more rapidly than those with less experience.
Also, vascular surgeons and thoracic surgeons who had the largest practice share of carotid revascularization were far less likely to reduce their use of the procedure compared with physicians from other interventional specialties.
And despite evidence that both patients older than 80 and those without symptoms tend not to benefit from carotid revascularization, the researchers did not find higher rates of decline among these patients.
According to the authors, as the use of low-value care is reduced, it's essential to gain a better understanding of the factors that affect a physician's decision to dial back procedures that may no longer be the most effective. The findings suggest the U.S. as a whole is not doing particularly well when it comes to that scaling-back process -- especially since plenty of fiscal wiggle room is necessary for the newer, more valuable innovations appearing in coming years.