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Health procedures scrutinized for costs, benefits

If you've had arthroscopic knee surgery for osteoarthritis, maybe you shouldn't have.  And if you've tried any of these treatments, there are questions, too, about whether it was worth it:

  • Pediatric Bariatric Surgery (under age 18, for obesity)
  • Discography (to diagnose back pain)
  • Virtual Colonoscopy (CTC)
  • Calcium Scoring for Cardiac Disease
  • Spinal Cord Stimulation (for pain relief)
  • Total Knee Replacement (multi-compartmental)

These treatments, and others, were evaluated by a committee of experts that looks at medical technologies that are expensive but may not be effective. Washington's Health Technology Assessment Program was created by the legislature five years ago. Its clinical committee, made up of medical professionals from a variety of disciplines, has reviewed the scientific literature for 21 treatments.

At its quarterly meeting next week, the committee will vote on whether certain blood tests make sense for children with diabetes, and on whether to deny payment on a surgery for back pain, which involves injecting pain killers around nerves in the spine.

The health assessment program falls into a growing field of study called "comparative effectiveness" research. It's meant to address a thorny question: which treatments really work?

"Health costs are going up, everybody knows this, and we spend more in this country than any other part of the world by far," says Dr. Craige Blackmore, a radiologist at Virginia Mason Medical Center in Seattle and chairman of the clinical committee. "And yet, our outcomes in this country aren’t necessarily any better than anywhere else, and one reason for that is there are a lot of things that we do for patients that aren’t necessarily beneficial."

Treatments often are approved for one condition, but then doctors start applying them in other areas, where they haven't been tested.  Also, after a medical device or treatment is approved by the federal Food and Drug Administration, it's rare for anyone to do follow-up studies on how patients are faring.

Interfering with doctors' and patients' choices?

The committee gets a lot of lobbying from specialists, who defend the procedures they use, and criticize the entire process of deciding which procedures should be covered and which not. Currently a group of "interventional pain specialists" is mobilized. They argue doctors should decide what they think is best for the patient -- and payment should not be withheld.

A free-market think tank, the Washington Policy Center, argues this way: "Used properly, comparative effectiveness research can help with cost-effective decision making while maintaining high standards in the practice of medicine. On the other hand, physicians spend four years in medical school and four to eight years in specialty training to be able to evaluate medical research. Having a government committee order providers to use certain treatments and diagnostic tools to use is, from a medical standpoint, arrogant, condescending and not in the best interest of patients."

Opponents pushed for legislation this year in Olympia, to dilute the power of the assessment process. But those bills appear to have died in committee.

Who is affected?

The decisions by the Health Technology Assessment program affect anyone with state-sponsored insurance, including state employees, low-income residents using Medicaid or Basic Health, and workers covered through Labor & Industries.

If a patient and doctor want to try one of the procedures that are no longer covered -- they can do it out of their own pocket.

In several cases, the committee decided to expand the payments for a treatment that had been questioned.

The decisions are watched closely, because Washington is the first state to empower a panel of experts to evaluate medical procedures. The federal comparative effectiveness program is just getting off the ground.

UPDATE: Opponents of the evaluation process plan to protest outside the meeting on the 18th, from 7:30-9:30 am. The protests are coordinated by the American Pain Foundation, which gets most of its funding from drug and medical device companies.

Keith Seinfeld is a former KNKX/KPLU reporter who covered health, science and the environment over his 17 years with the station. He also served as assistant news director. Prior to KLPU, he was a staff reporter at The Seattle Times and The News Tribune in Tacoma and a freelance writer-producer. His work has been honored by the American Association for the Advancement of Science (AAAS) and the Knight Science Journalism Fellowships at Massachusetts Institute of Technology.