Balancing the challenges of underdiagnosis (missing or delaying important diagnoses) and overdiagnosis (labeling patients with diseases that may never cause suffering or death) can feel like walking across a canyon on a tightrope. Diagnostic errors occur in an estimated 10 percent to 20 percent of cases and will affect most Americans at least once in their lifetime. They are the leading cause of medical malpractice claims, harming more than 4 million people at a cost of more than $100 billion. Continue reading
With the recent announcement of the American Cancer Society’s change in mammography and breast cancer screening guidelines, the question of when women should get screened is back in the spotlight. The issue is far from simple, as I learned when reporting on it last month for Cure Magazine, before the society’s change was announced.
As one researcher told me then, the goal of screening is to find a tumor that otherwise would not have been found – and find it early enough to undertake treatment that will save the patient’s life. Yet many other outcomes can also result from screening, ranging from false positives that can cause an intense (but hopefully brief) period of anxiety to identifying a non-invasive cancer that is treated with mastectomy, radiation or chemotherapy even if it never would have caused the woman harm. Continue reading
Her story, “Why Doctors Are Rethinking Breast-Cancer Treatment,” opens with an anecdote from now-60-year-old Desiree Basila, who several years ago decided to do … nothing after receiving a diagnosis of ductal carcinoma in situ (DCIS), a stage 0 cancer in the breast ducts that was not invasive – and may never become so. What makes this opening anecdote striking was not simply Basila’s decision – one that has been discussed more often in recent years – but when it occurred: Continue reading
In June 2009, Atul Gawande wrote an influential New Yorker article, about the community of McAllen, Texas, which has some of the highest per-capita Medicare costs in the nation. At the time, “The Cost Conundrum” had a significant impact on the national debate over the legislation that would become the Affordable Care Act – not so much on the health insurance coverage aspects but about wasteful spending and flawed incentives built into our payment system.
McAllen was awash in waste, fraud and abuse, with millions spent on care of little to no value to the patient. The spending could not be blamed on socio-economic factors because nearby El Paso was a very similar community, but with half the per capita Medicare costs, and same or better outcomes. Gawande wrote this about McAllen: Continue reading
For the past two years, as a health writer for the Texas Tribune, Becca Aaronson has been covering the state’s Medicaid orthodontic scandal.
A 2012 federal audit found that Texas Medicaid and Healthcare Partnership (TMHP), a Xerox subsidiary that had been processing Medicaid claims for the state since 2004, had been “essentially rubber-stamping” dental claims.
Questions about the system were first brought to light in the 2011 “Crooked Teeth” investigation aired by WFAA-Dallas. Aaronson credits that strong coverage with helping get her started on this story.
Aaronson’s most recent stories offered readers an update on the state investigation into allegations of widespread fraud and unnecessary treatment.
In a May 9 piece, she reported on the decision by the state Health and Human Services Commission to terminate its contract with TMHP. In addition, the office of the Texas Attorney General is suing Xerox in hopes of reclaiming hundreds of millions of dollars the company allegedly paid out for medically unnecessary Medicaid claims, she wrote.
In a recent conversation, Aaronson shared what got her interested in the story, how she pursued it over an extended period of time, how she got the documents she needed and her advice on using Medicaid claims data to report on potential fraud or overtreatment. Read more here.
The American health care system wastes an estimated $750 billion a year, according to the Institute of Medicine. At a recent AHCJ chapter event in Chicago, four panelists discussed one source of that waste: unnecessary tests and procedures.
Moderated and organized by AHCJ member Kevin B. O’Reilly, senior editor of CAP Today, the panel looked at the issue through the lenses of doctors, journalists, health system executives and academics.
Holly Humphrey, M.D., dean for medical education at the University of Chicago Pritzker School of Medicine and vice chair of the American Board of Internal Medicine Foundation’s board of trustees, discussed the foundation’s Choosing Wisely campaign. Continue reading