Washington Health Alliance Shows Sharp Variability in Use of Medical Procedures

One of the biggest burdens on business is the rising complexity and cost of health care. Every new advance in health care seems to come at a higher price. Its the tax that keeps on growing.

Fortunately, there is an antidote to the disease: transparency. Today, too many decision are made in the absence of information. Even physicians will admit in surveys that their decisions are based on subjective factors such as personal experience rather than on scientific evidence. Thats one reason as much as 30 percent of what we spend on health care is wasted on unnecessary procedures.

The Washington Health Alliance, whose membership is made up of large health care users such as Alaska Airlines and Puget Sound Energy; medical systems such as Group Health, Providence and UW Medicine; and hospitals such as Virginia Mason and Childrens, is trying to change all that by collecting data on the quality, cost and variability of care provided in this state.

This morning, the Alliance released a survey of the rate at which individuals of different ages and sexes have procedures in 15 counties in Western Washington. The survey revealed odd anomalies. Women aged 35 to 44 living in Puyallup are nearly three times as likely to have a hysterectomy as women living in Seattle. That surgery can lead to such complications as bladder and bowel injury and excessive bleeding.

When it comes to spine fusion, which joins together two or more vertebrae in the spine, the survey found that women in Olympia aged 45-54 were nearly three times more likely to have the surgery than their counterparts in Seattle. This surgery carries the risk of infection, damage to a spinal nerve leading to weakness, pain, loss of sensation and new spinal problems that can require additional surgery.

The large number of procedures contribute to rising medical costs. A hysterectomy can cost anywhere from $5,100 to $21,000, while spine fusion can cost from $15,000 to $58,000. [The variations in medical cost is another mystery.] The Alliance survey found statistical variance that suggested overuse of other costly procedures including sleep testing, CT scans and cesareans sections. Its unclear what causes the variation in price and surgery-rates, but possibilities include physician cultures that encourage certain procedures or spending on costly equipment that must then be paid for with more frequent use.

If we as a state want to lower cost we need to move towards lower prices for procedures and towards practices that reduce unnecessary surgery. That means doing more such studies. The Alliance plans, for example, to do an expanded study looking at 250 procedures and tests done in regions across the state.

We need the Washington State legislature to pass legislation requiring insurance companies and hospitals to release all information on medical costs so we can have the complete All-Payer Claims Database so many other states have. Only then can patients and companies make informed decisions about their medical care. House Bill 1437 currently before the legislature is a first step but it doesnt go far enough.

With complete information, patients, businesses and insurance companies can seek out quality care that is also the most cost effective. Those decisions will, in turn, drive institutions to improve their performance.

Conventional wisdom says market competition doesnt work when it comes to medicine. It certainly hasnt in the past. Maybe we in Washington can prove conventional wisdom wrong.