Proven Procedures

Four steps could reduce the performance of unnecessary surgery and improve the quality of surgical care without impairing a surgeon’s ability to care for a patient. First and most important, primary research is necessary to classify procedures into those that are of clear benefit, marginal benefit, and no benefit in specific groups of patients and to do so with enough detail to be applicable to the care of an individual patient. Professional societies would welcome such research if it were properly performed.

Second, if there were better information, payment policy could reflect standards of practice. For example, procedures found to be of no benefit in specific patient groups should not be a covered service. Patients should pay a large enough percentage of the cost of procedures of marginal benefit to have some personal investment in the decision. Procedures of proven benefit could be covered without deductibles and co-pays to encourage their use.

Third, patients could be required to review standard decision aids explaining the state of knowledge of procedures before payers agreed to pay for a procedure.

Fourth, specialist’s adherence to standards of practice and outcomes of surgery should be measured and reported so the public is protected.

While the steps proposed here may seem intrusive, they do not place a third party between a doctor and a patient; they do not ration needed services; and they do not inhibit the development of new technology. They do require that surgical procedures be proven effective in specific patient groups before their widespread promulgation. An entity such as the American Medical Quality System would perform such research.