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Gaping holes cited in medical care: to close the gaps, health care managers say it's time for doctors to rein in some procedures.

The gap between what doctors and nurses should do to treat patients and what they actually do to treat them is often very wide, according to health-care administrators. "Gaps between actual medical practice and what we know to be best practices are large and widespread," says Pat Venus, senior researcher at the consulting firm Ingenix. "And pressures are mounting to close those costly gaps."

The health-care industry has been on the defensive against accusations of inappropriate medical practices that often drive up the cost to insurance companies.

At the 2004 Ingenix Health Information Summit earlier this year, there was no shortage of slides highlighting reports of medical errors and hospital staff administering too much care--or sometimes not enough--to patients.

Health managers at the conference weren't shy about using the industry's new buzzword, "evidence-based medicine," or EBM. The technique is designed to cut the incidence of mistakes and improve disease management to slow the rising cost of health care by basing procedures on proven medical practices.

Dr. Reed V. Tuckson, a senior vice president at UnitedHealth Group, which owns Ingenix, said that as many as 50 percent of patients who suffer a heart attack are not properly medicated afterward. The use of antibiotics, and the propensity of doctors to operate, has become too widespread, he also said.

Tuckson said that methods of assessing physician competence are making their way through accrediting boards. He described a pilot approach at UnitedHealth that uses a point system to rate physician adherence to evidence-based Medicine.

Analyzing claims from more than 40,000 insured individuals, Janis Diring-Khan, director of evidence-based products at Ingenix, said she found significant decreases in the cost of care, for example, when patients adhered to a regimen of inhibitors or lipid-lowering drugs.

However, Dr. Monika M. Safford, with the University of Alabama's Division of Preventive Medicine, cautioned that patient populations in studies used for evidence-based medicine may be different from those in many office practices, in terms of patients' attitudes, beliefs and ability to afford care.
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Title Annotation:Upfront: news, updates and other emerging strategies from around the world
Author:Allen, Russ
Publication:Risk & Insurance
Date:Oct 1, 2004
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