The sixth of the new national health care reform priorities is eliminating overuse. More precisely, overuse refers to duplication of services and higher than necessary level of care, such as hospitalizing people who can be treated in a sub-acute nursing facility. The former is straight forward and the PPACA Patient Safety Amendment (PSA) can easily contain wording that would prohibit doctors from ordering unnecessary diagnostic tests such as lab work, X-rays and scans. For example, let’s say a primary care physician has obtained blood work and X-rays and then referred the patient to a specialist because some of the results were abnormal. If the specialist orders a repeat of the tests as a matter of policy for all newly referred patients that is a duplication of services. The PSA can easily abolish this practice by making the doctors pay for any such duplicate diagnostic testing.
The second component of overuse is providing more expensive higher levels of care than what the patient needs. For example, intensive care versus regular hospital floor is a serious problem regarding overuse. However, there is the question of patient safety vis-à-vis staffing issues. A physician is going to be reluctant to transferring a patient to a regular floor from the ICU knowing that the floor units are understaffed to the point of being dangerous. On the other hand, one area of overuse that is more easily discernable, as mentioned previously, is the practice of transferring nursing home residents to hospitals for minor health problems that can be treated safely at the nursing home. This practice must be abolished by directing the CMS to change its reimbursement policies.