Outline a AUDIO for this section of the project PowerPoint presentation explaining the supply of unnecessary treatment
Question:
Outline a AUDIO for this section of the project PowerPoint presentation explaining the supply of unnecessary treatment in healthcare, covering the issue, stakeholders, various solutions, picking the best solution, justifying your best solution, and providing a strategy to execute and implement your solution. You should pay attention to the following points: The economic or policy problem, issue, or phenomena, as well as a synopsis of the issue, to include stakeholders affected by the issue, problem, or phenomenon. Summary of your three solutions, with at least one strength, weakness, opportunity, and threat for each. The rationale for implementing the optimal solution. Determine the best answer for each of the three options and support your decision with evidence-based research. Explain how you intend to carry out and implement your solution.
Be detailed in your proposal, and back it up with reputable resources.
Annotated Bibliography
The provision of unnecessary treatment is a serious concern in the healthcare system. Overuse and unnecessary care are estimated to account for up to 50% of all healthcare costs, with most of these costs incurred in the last year of life. Unnecessary care is care that is provided but provides little value to the patient or provides little benefit in comparison to the cost of providing it. Inequitable incentives in how we pay for care are intimately linked to the problem of unnecessary treatment. Clinical services are frequently reimbursed by health insurance, even if the patient does not profit from them. As a result, healthcare providers are encouraged to overprescribe treatments, increasing system cost and waste.
The problem of unnecessary care is exacerbated by growing healthcare costs for the average family, as well as the switch to high-deductible plans, which makes it more difficult for middle-class families to use their insurance. Although the Affordable Care Act (ACA) was intended to address some of these issues, not-for-profit hospitals have not seen the anticipated advantages. Another exacerbating element is cost-shifting, which is the practice of charging higher prices to one group of patients to provide free care to the uninsured.
Another element to examine is the breadth of the medical care financing issue. As medical bills absorb a larger share of the nation's production, this issue is attracting more attention. National health policy should prioritize cost minimization, and several strategies are available to achieve so. Unexpected consequences of cost-cutting, such as decreased care quality or restricted access to treatment, must also be considered.
The Blue Cross Blue Shield antitrust case is related to the issue of unnecessary medical care. The issue involves two plaintiffs: one group claims that the consolidation of BCBS has resulted in higher insurance premiums and less competition, while the other claims that consolidation has resulted in lower costs and lower reimbursement. The case has the potential to have a significant influence on healthcare prices as well as broad ramifications for the insurance sector.
Ultimately, the growth of personalized treatment is linked to the issue of unnecessary care. Concierge medicine is when patients pay a fee for personalized care. This sort of care could improve access to care and customize care, but it also has the potential to increase class inequities and boost costs.
To conclude, there is an urgent need to address the problem of unnecessary treatment in the healthcare system. The issue is intertwined with a number of other issues, including cost-shifting, the severity of the healthcare financing issue, the rise of concierge medicine, the perverse incentives in how we pay for care, the rising cost of healthcare for the average family, the anti-trust case against Blue Cross Blue Shield, the lack of ACA benefits for not-for-profit hospitals, and the anti-trust case against Blue Cross Blue Shield. When addressing the issue of unnecessary treatment, it is vital to consider all these aspects, as well as any potential implications.
References
Chernew, M., & Landon, B. (2020). Unnecessary use of medical care: An economic and policy perspective. Annual Review of Public Health, 28(1), 377-395. doi: 10.1146/annurev.publhealth.28.021406.104545
Gates, S. M. (2020). The cost-shifting debate: Unraveling the complexities, unearthing the facts. Journal of Healthcare Management, 53(5), 315-323.
Hoffman, A. (2019). The Anti-Trust Case Against Blue Cross Blue Shield: Assessing The Merits. Yale Law School, 126.
Topic/Problem Analysis
Unnecessary therapy is a major concern in the healthcare system, including many different facets of the issue, problem, or phenomena. It refers to medical techniques or procedures that are ineffective or even harmful to patients. Overprescribing drugs, conducting unneeded tests or screenings, performing needless procedures, or giving excessive and lengthy hospital stays are all examples of inappropriate care. This is a critical issue since it not only has an impact on patient outcomes and treatment quality, but it also adds to rising healthcare expenses.
A variety of reasons contribute to the frequency of needless therapy. One element is medical technological improvement, which has expanded the availability of diagnostic tests and therapies. While technological innovations have clearly enhanced patient care, they have also provided healthcare practitioners with additional options and incentives to adopt these interventions, even when they may not be essential.
Inadequate treatment is also influenced by skewed incentives within the healthcare system. Fee-for-service reimbursement arrangements, in which providers are paid based on the number of services they deliver rather than the quality or value of those services, might incentivise overutilization. This payment structure may induce healthcare practitioners to perform needless tests or treatments to increase income.
Another issue that contributes is a lack of evidence-based medicine. Evidence-based medicine is making patient care decisions based on the best available evidence. However, there might be a disconnect between the most recent study findings and clinical practice. Because of a lack of understanding or aversion to change, healthcare practitioners may continue to utilize obsolete or ineffective therapies.
Because of the influence on patient safety, healthcare quality, and affordability, the issue of unneeded treatment must be addressed. Unneeded therapy can put patients at risk of injury, such as bad medication responses, surgical problems, or unneeded radiation exposure from diagnostic testing. Furthermore, needless therapy depletes vital healthcare resources, taking them away from individuals who truly require them. This adds to increased healthcare expenses, which can impose a financial strain on people, corporations, and government programs in charge of healthcare finance.
Changing the incentives within the healthcare system and enhancing the transmission and acceptance of evidence-based methods are two of the most difficult parts of the issue of unneeded treatment. Shifting away from fee-for-service compensation models and toward value-based payment systems, in which clinicians are rewarded for providing high-quality, cost-effective care, can help minimize financial incentives for unneeded treatment. Furthermore, encouraging the implementation of evidence-based recommendations and clinical pathways may assist standardize care and ensure patients receive the most appropriate and effective therapies.
The general population, healthcare professionals, and third-party payers are all affected by unneeded treatment. The general population is harmed because they may be subjected to unwarranted interventions that might cause bodily and financial harm. Patients may face greater out-of-pocket payments, higher insurance premiums, or limited access to care because of poor resource allocation. Healthcare practitioners may experience difficulties in providing high-quality care because needless therapy diverts their time and resources away from patients who truly require it. Third-party payers, such as insurance companies and government programs, incur the financial burden of needless treatment in the form of increased healthcare expenses and premiums, which can have an impact on the affordability and sustainability of healthcare coverage.
To summarize, needless treatment is a major challenge in the healthcare system. It is caused by a variety of circumstances, including advances in medical technology, unbalanced incentives, and a lack of evidence-based treatment. This issue must be addressed to maintain patient safety, enhance healthcare quality, and make healthcare more affordable. The general population, healthcare professionals, and third-party payers are all impacted by unneeded treatment, with the effects affecting patient outcomes, access to care, and financial ramifications. Addressing this issue involves changes in compensation methods, the promotion of evidence-based procedures, and a concerted effort among stakeholders to ensure that patients receive appropriate, effective, and cost-conscious treatment.
References
Commentary: My cancer might be backand I wonder if unnecessary radiation caused it in the first place. (n.d.). Fortune.https://fortune.com/2020/09/22/health-care-unnecessary-medical-treatment/
Shrank, W. H., DeParle, N.-A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health costs and financing: Challenges and strategies for a new administration. Health Affairs, 40(2), 235-242.https://doi.org/10.1377/hlthaff.2020.01560
Options
Within the context of the current state of the healthcare system, the problem of "To much unnecessary care", is becoming an increasingly urgent one. In medicine, "unnecessary medical care" can refer to operations or treatments that do not yield substantial outcomes or give significant advantages. Many economists and healthcare experts believe that a considerable portion of medical treatment provided to patients is unnecessary, and that the use of needless care is the primary cause of waste and inefficiency in the healthcare system. The phrase "unnecessary therapy" refers to treatments, tests, and interventions that are either not required by medical standards or contribute only marginally to a patient's overall health improvement. The word "unnecessary therapy" refers to medical operations, tests, and treatments that are either not required by accepted medical standards or have minimal influence on a patient's health. Financial incentives, patient demand, or medical prejudice may all motivate these procedures. Unnecessary therapy, on the other hand, might raise healthcare expenses and endanger patients. It is critical to find a solution to this problem since it might lead to a number of consequences, including an increased financial load on the health-care system, a reduction in patients' access to care, and worse health effects. Finding a solution to this challenge requires a rationalneed to change. Without acknowledging the need for change, the situation may worsen, resulting in increasing financial burden on the healthcare system, restricted patient access to care, and bad health outcomes. These issues can be avoided or mitigated by recognizing the need for change and taking effort to find a solution. As a result, it is necessary to conduct an in-depth investigation into the factors that lead to unnecessary therapy, the impact that it has on various stakeholders, and the solutions that are being considered to fix this problem.
Uninformed patients may favor therapies that give little to no benefit because they are unaware of the existence of evidence-based therapy. This might result in a lack of demand for successful therapies and the spread of ineffective or even hazardous ones. Furthermore, if healthcare practitioners do not practice evidence-based medicine, they may be more prone to administer these poor therapies in response to patient demand or merely out of habit. Ultimately, this can lead to a waste of money and inferior health consequences for patients. Payers have put in place incentives that reward physicians for greater utilization of services, and these incentives reward physicians for greater utilization of services. As a result of these factors, healthcare providers are placed in a position where they are incentivized to provide additional treatments beyond what is regarded as necessary, frequently without providing a comprehensive justification or conducting an in-depth analysis of the individual patient. There are some providers who, due to financial or technological limitations, are unable to incorporate evidence-based medical interventions into their practice.
The implications of this matter are widespread, and they touch on several different parties who have a stake in the outcome. Patients are at risk of receiving treatments that offer little to no benefit, including the possibility of harm from excessive treatment or an incorrect diagnosis because of tests and interventions. The economy is also a crucial factor to consider because unnecessary medical care drives up costs for everyone involved, including healthcare providers, payers, and the public. Access to care may also be hampered because resources may be redirected away from those individuals who have the greatest requirement for them.
Recommendation solution #1: encourage providers to communicate more effectively with patients and recommendation solution #2: promote evidence-based medicine, the Patient Protection and Affordable Care Act (ACA) has set out to combat this problem. In addition, some insurance companies have tried to limit the number of medical services their customers use by implementing incentives and penalties. Nevertheless, the cost-shifting argument and the antitrust case brought against Blue Cross Blue Shield show that these measures might not be the most effective way to go about things.
Because of this, it is critical that additional actions steps be taken to effectively combat the phenomenon of unnecessary therapy. Improving coordination among stakeholders can result in increased coherence in decision-making and more effective resource usage. This can also motivate doctors to speak more effectively with patients since they may have a better awareness of the healthcare system's overarching aims and priorities. Working together, stakeholders may identify areas for improvement in communication and collaboration and establish plans to solve these challenges. Ultimately, this might result in improved patient health outcomes and a more sustainable healthcare system overall. Furthermore, healthcare practitioners should drive decision-making and determine whether a treatment is appropriate for their patients. To assist guide decision-making in practice, evidence-based medicine incorporates the best available research data, clinical experience, and patient values and preferences. Information-based decision-making is the technique of making decisions after examining available facts, expert opinion, and patient priorities. For patients to be able to make educated decisions about their healthcare and for providers to understand the implications of the treatments they are administering, there is a need for improved education and communication on both sides: patients and providers.
In general, the problem of unnecessary therapy is a difficult one that can have far-reaching repercussions. It is imperative that all parties involved, including patients, payers, and healthcare providers, collaborate to stop it from becoming an even more significant issue within the healthcare system. Additional research must be conducted to identify the approaches that will be most successful in resolving the issue and to guarantee that these approaches will be used. It is only under these conditions that the health care system can function in an efficient and effective manner, providing treatments that accurately reflect the requirements of each individual patient and allocating resources in an appropriate manner.
SWOT when encourage providers to communicate more effectively with patients:
Strengths:
- Improved patient satisfaction and trust in healthcare providers
- Better patient outcomes due to increased understanding and adherence to treatment plans
- Increased efficiency in healthcare delivery as patients are more likely to follow through with appointments and treatments
Weaknesses:
- Resistance from some providers who may not see the value in improving communication skills
- Time constraints on providers who may already have a heavy workload
- Lack of resources or training for providers to improve their communication skills
Opportunities:
- Implementation of communication training programs for healthcare providers
- Integration of technology such as telemedicine or patient portals to facilitate communication between patients and providers
- Potential for increased revenue as satisfied patients are more likely to return for future care
Threats:
- Legal implications if poor communication leads to medical errors or malpractice claims
- Negative impact on provider reputation if poor communication is reported by patients
- Resistance from insurance companies or other stakeholders who may not see the value in investing resources into improving provider-patient communication.
Promoting Evidence-Based Medicine (EBM):
Another solution to address unnecessary medical care is to promote the use of evidence-based medicine. EBM involves integrating the best available research data, clinical experience, and patient values and preferences into the decision-making process. By encouraging healthcare practitioners to follow evidence-based guidelines and treatment protocols, unnecessary or ineffective treatments can be avoided. This requires ongoing education and training for providers, as well as creating a culture that values and prioritizes evidence-based practice.
Strengths:
- Improved patient outcomes through the use of effective and appropriate treatments.
- Reduced variability in care delivery, leading to more consistent and standardized practices.
- Increased cost-effectiveness by avoiding unnecessary interventions.
Weaknesses:
- Resistance from providers who may have long-standing practices or beliefs that are not aligned with evidence-based guidelines.
- Challenges in accessing and interpreting up-to-date research data.
- Incorporating patient values and preferences may introduce subjectivity and require shared decision-making.
Opportunities:
- Continued education and training programs to ensure providers are up-to-date with the latest evidence.
- Development of clinical decision support tools that integrate evidence-based guidelines into practice.
- Collaboration among researchers, clinicians, and patients to identify and prioritize research needs.
Threats:
- Limited resources and funding for research and training in evidence-based medicine.
- Potential conflicts of interest among stakeholders, such as pharmaceutical companies promoting treatments without strong evidence.
- Resistance from providers who may perceive evidence-based medicine as restrictive or constraining their autonomy.
3. Addressing Financial Incentives and Payment Models:
Financial incentives and payment models in healthcare can play a significant role in driving unnecessary medical care. Fee-for-service reimbursement, for example, may incentivize providers to perform more procedures or tests, even if they are not medically necessary. To address this issue, alternative payment models that prioritize value-based care and outcomes can be implemented. These models reward providers for delivering high-quality care and achieving positive patient outcomes while reducing unnecessary interventions. Additionally, transparent pricing and cost-sharing mechanisms can empower patients to make more cost-conscious decisions and avoid unnecessary care.
Strengths:
- Aligning financial incentives with high-quality, cost-effective care.
- Encouraging providers to focus on outcomes and value rather than volume.
- Empowering patients to make informed decisions about their healthcare based on cost and value considerations.
Weaknesses:
- Resistance from providers who may be hesitant to transition to new payment models or fear financial uncertainty.
- Challenges in accurately measuring and assessing quality outcomes.
- Potential for unintended consequences, such as underutilization of necessary care if cost containment becomes the primary focus.
Opportunities:
- Development and implementation of alternative payment models that reward value-based care.
- Integration of cost transparency tools into healthcare systems to empower patients.
- Collaboration among payers, providers, and policymakers to design payment models that address unnecessary care.
Threats:
- Resistance from healthcare systems and providers who benefit from the current fee-for-service reimbursement structure.
- Political and regulatory challenges in implementing new payment models.
- Potential disruption and uncertainty during the transition to new payment systems.
To summarize, tackling the issue of unneeded medical treatment necessitates a multifaceted strategy. Encouraging efficient provider-patient communication, supporting evidence-based treatment, and addressing financial incentives and payment structures are three rational and research-based answers to the problem. By using these technologies, healthcare systems may decrease waste, enhance patient outcomes, and guarantee resource allocation is efficient.
References:
Commentary: My cancer might be backand I wonder if unnecessary radiation caused it in the first place. (n.d.). Fortune.https://fortune.com/2020/09/22/health-care-unnecessary-medical-treatment/
Shrank, W. H., DeParle, N.-A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health costs and financing: Challenges and strategies for a new administration. Health Affairs, 40(2), 235-242.https://doi.org/10.1377/hlthaff.2020.01560
Fundamentals of Thermal-Fluid Sciences
ISBN: 978-0078027680
5th edition
Authors: Yunus A. Cengel, Robert H. Turner, John M. Cimbala