President Obama stirred up more than a few doctors last week when he suggested that some doctors order procedures or tests because it’s more profitable for them.
Here’s the transcript of what he said, courtesy of the New York Times:
Certainly, no one likes to be called a profiteer, so on that level alone, this comment didn’t sit well. But the numbers and the science don’t bear out the President’s argument. Medicare’s basic fee schedule pays a surgeon $241 for a pediatric tonsillectomy, and $233 for one performed on an adult. And, I don’t know any doctor who would recommend one based on a recurrent sore throat. The American Academy of Otolaryngology issued a detailed, eloquent defense of why tonsillectomies are often medically necessary, and can be less expensive than treatment without surgery.
Here’s the transcript of what he said, courtesy of the New York Times:
"Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that's out there. So if they're looking and -- and you come in and you've got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out.'
"Now, that may be the right thing to do. But I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies. Maybe they have something else that would make a difference."
Certainly, no one likes to be called a profiteer, so on that level alone, this comment didn’t sit well. But the numbers and the science don’t bear out the President’s argument. Medicare’s basic fee schedule pays a surgeon $241 for a pediatric tonsillectomy, and $233 for one performed on an adult. And, I don’t know any doctor who would recommend one based on a recurrent sore throat. The American Academy of Otolaryngology issued a detailed, eloquent defense of why tonsillectomies are often medically necessary, and can be less expensive than treatment without surgery.
This episode illustrates why comparative effectiveness research is so badly needed in this country today. Instead of determining medical necessity by anecdote (hypothetical or real; they’re equally dangerous) let’s get some solid research going, and learn authoritatively what helps patients. That will make our health care system better and more efficient by leaps and bounds.
Mario E. Motta, MD
President, Massachusetts Medical Society
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