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Medical Decision Support Can Save Surgery Dollars

By Stephen Miller  9/29/2010
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Providing employees with access to medical decision support (MDS) advice services can cut medical spending costs by reducing unnecessary elective surgeries and treatments, according to presenters at the 24th National Conference on Health, Productivity & Human Capital, speaking on Sept. 15, 2010, in Washington, D.C.

David Hines, president of Consumer's Medical Resources, an MDS provider, demonstrated the extent of the problem by noting some recently published statistics:

70 percent of conditions have more than one treatment option, yet patients often are presented with only one option by their doctor (New England Journal of Medicine).

30 percent of conditions have a known best practice, but it is followed only half the time (New England Journal of Medicine).

Location, not best practice use, determines which treatments are most likely to be recommended by physicians. In Santa Barbara, Calif., a patient is six times more likely to have back surgery than one in the Bronx, N.Y. (Dartmouth Atlas).

Up to 40 percent of each dollar spent on health care goes to unnecessary tests, unwarranted therapies, medical errors and administrative complexity (Institute of Medicine).

The Internet often provides patients with advice that is inaccurate, misleading and counterproductive (American Family Physicians).

"With access to and incentives to use MDS services, patients often chose less-invasive options for knee and back surgeries," Hines noted. Other surgeries that are often avoidable with alternative, less-invasive therapies include hip replacements and hysterectomies, he said.

"It's all about informed decision-making," added Mary Egan, director of health care at Honeywell Corp., which provides its employees with MDS services for more than 60 medical conditions."If you don't have to go through surgery, most patients would prefer not to. But knowledge is needed to make informed decisions," she said. "Getting the right information into employees' hands allows them to have an informed conversation with their doctor so they can make the best decision."

The MDS program at Honeywell and other organizations is voluntary, independent and confidential. The advice typically is provided over the phone by medical researchers making use of physicians from top medical schools and an extensive database. Also provided: access to an MDS web site to view or download treatment data and personalized reports.

Providing Incentives

At Honeywell, Egan noted, employees who use the available MDS services prior to treatment for one of eight conditions that have more than one effective treatment option, including lower-back pain, receive $500 into their health reimbursement arrangement—whether they chose a less-invasive, lower-cost alternative therapy or not. Of Honeywell's 2,000-plus employees who have used the MDS services, 35 percent switched to treatments considered best practices and 23 percent discontinued unnecessary or questionable treatments, Egan said.

The message to employees, she summed up, is: "Learn more, earn more, get informed."

Stephen Miller is an online editor/manager for SHRM.

Related Articles:

Have Surgery, Will Travel—Domestically, SHRM Online Benefits Discipline, March 2011 

Beyond Plan Design: A Multidisciplinary Approach to Health Costs, SHRM Online Benefits Discipline, March 2010

Managing Diabetes: Incentives and 'Coaches' Improved Health, Lowered Costs, SHRM Online Benefits Discipline, May 2009

Health Coaching: A Helping Hand for Getting Better, Staying Well, SHRM Online Benefits Discipline, May 2007

Quick Links:

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SHRM Online Health Care Reform web page 

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