Doctors Recommending Surgery for Profit Motive?

If your doctor is pushing you toward non-emergency surgery for the wrong reason?

Financial incentives sway doctors to send patients to surgery, study says

August 16, 2010 | Christina Jewett

Is a doctor who stands to profit from sending you to surgery more likely to suggest that you get a procedure? The answer is a resounding yes, based on one researcher’s analysis of five years worth of insurance claims in Idaho.

The study, published in the August edition of the Archives of Surgery, looked at the behavior of doctors who own all or part of a specialty hospital or ambulatory surgery center.

Researcher Jean M. Mitchell found that patients of facility-owner physicians are:

  • 54 to 129 percent more likely to get carpel tunnel repair
  • 33 to 100 percent more likely to get rotator cuff repair
  • 27 to 78 percent more likely to arthroscopic surgery

Mitchell concedes one weakness of the study is the gap in data about whether the surgeries were beneficial to the patients. One of the categories, arthroscopic surgery of the knee, was identified in one study to yield no better benefit than medical or physical therapy. Yet it costs $5,000 per case, twice to three times the cost of lower-intensity care.

Mitchell, who is a professor at Georgetown University, concludes “that financial incentives linked to ownership of either specialty hospitals or ambulatory surgery centers influence physicians’ practice patterns.”

Typically, “self-referral” is illegal in health care, Mitchell notes. However, federal law makes an exception for doctors referring patients to hospitals and surgery centers.

The findings, in a way, erode the notion that doctors always do what is best for the patient. And they build on work of other researchers highlighting the way capitalism and wellness do not always align.

One recent study by a Stanford researcher found that local MRI supply tends to drive MRI usage and incidence of lower back surgeries (as opposed to, say, actual need for such services).

And a University of California Davis researcher delved a case of money and politics mixing with medicine, resulting in a windfall for one company but no discernible benefit to patients. His study examined a medical device company’s role in lobbying for a mammography-screening process that increased false-positives but did little to increase cancer detection.

Medical research is amassing examples that Gordon Gecko would love. But whether they are best for patients is a matter that deserves more scrutiny and more debate.

Such debate started in earnest last week in Sacramento, when the New America Foundation hosted a crowded hearing in the Capitol about aligning incentives in medicine that ensure “effective care that takes into account the latest findings in medical science as well as the preferences of individual patients and the judgments of their healthcare providers.”

For now, one antidote to medical profiteering that’s being discussed in policy circles is the “accountable care organization,” which is essentially an HMO that rewards doctors for keeping patients healthy rather than racking up the fee-for-service bill.

Dr. Atul Gawande, a physician who pens long, thoughtful pieces in the New Yorker, called for a movement toward health systems where the temptation to make choices for profit disappears and the incentives are in line with what’s is best for patients:

Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone – because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health care system in the world.

Note:   The above was taken from http://californiawatch.org/dailyreport/financial-incentives-sway-doctors-send-patients-surgery-study-says-4041

Doctor Recommending Surgery Profit Motive?

I was searching for a different article I had seen reporting that doctors who had financial interests in surgical clinics were more likely to recommend non-emergency surgery for conditions such as carpal tunnel syndrome, thoracic outlet syndrome, cubital tunnel syndrome, and others.

I haven’t found that article yet.  But here is this one…

Doctors with ownership in surgery center operate more often, U-M study finds

ANN ARBOR, Mich. — When doctors become invested in an outpatient surgery center, they perform on average twice as many surgeries as doctors with no such financial stake, according to a new study from the University of Michigan Health System.

“Our data suggest that physician behavior changes after investment in an outpatient facility. Through what some have labeled the ‘triple dip,’ physician owners of surgery centers not only collect a professional fee for the services provided, but also share in their facility’s profits and the increased value of their investment. This creates a potential conflict of interest,” says study author John Hollingsworth, M.D., M.S., a Robert Wood Johnson Clinical Scholar at the U-M Medical School.

“To the extent that owners are motivated by profit, one potential explanation for our findings is that these physicians may be lowering their thresholds for treating patients with these common outpatient procedures,” Hollingsworth adds.

The study looked at all patients in Florida who underwent one of five common outpatient procedures: carpal tunnel release, cataract excision, colonoscopy, knee arthroscopy and myringotomy with tympanostomy tube placement (a procedure to insert tubes in the ear).

The researchers determined which doctors were owners of a surgery center. They then compared surgery use among owners in two time periods—before and after they acquired ownership—with that of physicians who remained non-owners.

Results of the study appear in the April issue of Health Affairs. The findings include:

  • Owners operated on an average of twice as many patients as non-owners.
  • While caseloads increased overall between the earlier and later time periods for all physicians, the increases were more rapid and dramatic among owners.

 

The number of surgery centers has increased nearly 50 percent over the last decade, largely driven by the investment of physicians, who had a stake in 83 percent of these facilities. For doctors, investment may give them more control over their practice environment, from scheduling cases to purchasing surgical equipment. For patients, these centers often have shorter wait times than hospitals and may provide more amenities.

“There are some definite advantages for surgeons, as well as patients, associated with care at surgery centers. However, we need to better understand the implications of these new findings, in particular their overall effect on health care expenditures. Insofar as our results are due to lowered treatment thresholds, policymakers should consider, at the very least, requiring all physicians to disclose their financial interests to their patients,” Hollingsworth says.

Contact: Nicole Fawcett
nfawcett@umich.edu
734-764-2220
University of Michigan Health System

###

Additional authors: Zaojun Ye, research associate in urology at U-M; Seth A. Strope, assistant professor of surgery at Washington University in St. Louis; Sarah L. Krein, research associate in internal medicine at U-M; Ann T. Hollenbeck, partner at Honigman Miller Schwartz and Cohn LLP in Detroit; and Brent K. Hollenbeck, associate professor of urology at U-M

Funding: Hollingsworth is a Robert Wood Johnson Clinical Scholar; Hollenbeck is supported in part by a Mentored Research Scholarship Grant from the American Cancer Society

Reference: Health Affairs, Vol. 29, No. 4, April 2010

Quick Carpal Tunnel Remedy

Many years ago when I was developing hand problems, I was looking for answers to work on myself. 

The stretches I learned in massage school weren’t  helping.  Icing gave relief, but I knew there had to be a better, more lasting way than dipping my arm in alternating cold and hot water or applying ice packs.

Most books and articles weren’t very helpful. 

The first quick method that worked came from a most unusual source. 

Watch the Video to See What Changed Everything.

The video referred to is at Carpal Tunnel Treatment

Then I worked on ways to not have to use my thumbs.
Then I expanded the method.

Then I got numb fingers when I raised my arms to steering wheel level, but not when my arms were down.

This technique  didn’t solve that because the problem was coming from somewhere completely different. 

And so I worked out a self-massage technique for this new area, and the results were almost instant.

Lumps  in the Low Back – Top of Hip

Do you have lumps in your low back, or across the top of you hip bone?

These are firm, movable lumps in between the skin and the muscle or in between the skin and the top of the hip bone (the iliac crest).  They are also found the “dimple” between the butt and the low back. They can range in size from very small and round to oblong and several inches long.

First let me tell you they are NOT cancer and they are not malignant.

They are also not lymph nodes (because you don’t have them there).

But if you have low back troubles, it important that your read on.

The lump is a back mouse.  I’ll give you some other names so you can do further research if you like or you wish to see a doctor about them. Other terms are: Episacral lipoma, iliac crest pain syndrome, multifidus triangle syndrome, and lumbar fascial fat herniation

They are quite common.  As a massage therapist, I have felt them on hundreds of people.For a long time, nobody I asked could tell me what they were.

It is estimated that between 10% to 25% of the population has them.

They are not in the muscle, so they are not “knots”.

They are like lipomas (fatty lumps) that a lot of people get.  But lipomas are never painful when you push on them.

However,  back mice can be painful when you push on them.  Most people who have them can live with them.  BUT….

In about 10% of the people who have them they can cause excruciating back pain, or refer pain down the leg or into the knee.

They mimic a herniated disc.  And probably the majority of doctors are not aware of this.

What they are is fat that has leaked (herniated) through a rip in the facia (membrane) and often take nerves with it.  These rips can be caused by trauma, lifting, sitting too much, or other possible causes.

Like trigger points, which are tender spots in muscles, back mice can refer pain to somewhere else on the body.  But trigger points can be massaged away with pressure.

Back mice should NOT be massaged, because that only creates more pain.  Massaging will not make them go away.

Massaging the back MUSCLES is a good idea. BUT NOT THE LUMPS.

If the back pain caused by these has only lasted a few weeks or less, the pain will likely go away by itself. Maybe it is because the nerve retracted itself or maybe the hole closed around the nerve and the nerve died.  I don’t know.

If you have chronic back pain or pain radiating down a leg, you should check to see if it is caused by a back mouse, before submitting to an MRI or other expensive procedures.

Lie face down wearing loose pants (no jeans or belts).  Have a friend feel the low back (around waist level) and on the upper part of the hip bone for lumps.  Have them push fairly hard on any lump they feel.

If pushing on a lump causes the the same pain you have been having, bingo. Then you can probably blame the back mouse.

The next step is to see a doctor or clinic (write down the earlier mentioned medical terms for reference).  The true test to see if the back mouse is causing your pain is to have it injected with anesthetic.  If that makes the pain go away, you have found the culprit.  The anesthetic wears off in a couple hours.

Just about any doctor or qualified medical person could inject the anesthetic.

Be warned that most doctors will know about regular lipomas but not these things.  So it is best to call and find out if they are familiar with them to save yourself frustration of going from doctor to doctor.

But for the actual surgery, if it were my back, I’d like someone with experience with these things, even though it is not major surgery.  Besides removing the lump, the hole in the facia needs to be mended.

If the back mouse is causing the pain what can you do about it?

I do not know of any technique to get rid of the back mice. except surgery.  

As I may have mentioned, about 90% of the people who have them are not seriously bothered by them.  

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Chiropractic may help to some extent, as would massage of the muscles – not the mice.

Drugs and pain killers do not help.

Forward stretching and twisting are not advised while you are in pain.

Ice packs may be helpful for pain.

Rub on Relief, is a natural, effective pain relief cream.

This is just about all I know about back mice.  Please Comment, but I can’t really answer questions about them.

If you have sciatic pain, check into Sciatica Treatment At Home.

Note:  more recently I posted a video about this http://discomfortfree.com/2012/11/lumps-over-top-of-hip-low-back-video/

******* Here is a free article with medical terminology that you can print out and show to a doctor click here DO NOT GO TO A DOCTOR WITHOUT THIS.

 Note:  If you didn’t see Robbie’s comment below, here it is.  It may help you if you are looking for a doctor that can help you..

“Just thought I’d add my 2 cents for those of you looking for a doctor to remove your back mice. I went to a Plastic Surgeon and he gladly, easily and skillfully did the surgery. And affordably too since I pre-negotiated the price. He sewed up the tear (which he said was quite large) and let me see the fat blob that he had to remove. There were 2 large nerves running through it. Youch! Don’t give up. Take this article with you and go see a Board Certified Plastic Surgeon. Mine was a hand surgeon in Park City, Utah. They’re very skilled with nerves and delicate work like this. The recovery wasn’t fun but it was way better than the pain that I lived with for 2 long from the dang mouse! Good Luck”.