Saturday, April 21, 2018
Health

With elective surgery, where you live is what you get, says new study

Whether Medicare patients undergo elective surgeries has a lot to do with where they live, according to a study released this week.

Seniors with heart disease are half as likely to undergo balloon angioplasty if they live in Savannah, Ga., than if they live in Gainesville. Patients are nearly three times more likely to get their knees replaced if they live in Roanoke Rapids, N.C., than if they live in Miami Beach.

The findings led researchers at the Dartmouth Institute for Health Policy & Clinical Practice to come to this conclusion: Patients are letting their doctors, who are entrenched in the local medical culture, make decisions for them.

"Many patients aren't even aware that the choice about elective surgery is theirs to make," said lead author Shannon Brownlee. "The result is that patients don't really get the treatment they prefer."

The report by the group, which is affiliated with Dartmouth College in New Hampshire, is part of its well-known Dartmouth Atlas Project, which tracks health care trends and has reported on wide geographic variations in Medicare spending for more than 20 years.

Last year the project released a report that found differences in elective surgery rates among the regions of the country. The latest report examines variations between 2008 and 2010 within the regions, even within the states.

Researchers studied more than 500 hospital markets (geographic areas served by a small number of hospitals) in the South Atlantic region. The treatment included 10 elective surgeries — including hip replacements, mastectomies and gallbladder removal — and the PSA screening test for prostate cancer.

The report divided the Tampa Bay market into four regions with referral hospitals: Clearwater, Hudson, St. Petersburg and Tampa. Drawing conclusions about any particular hospital's practice is difficult, however, because the rates track where people live, not where they get their procedures.

So a Medicare beneficiary who lives in Clearwater but got treatment in Tampa would be counted as a Clearwater patient, not a Tampa patient.

There were some rates that stood out. In Hudson, where Regional Medical Center Bayonet Point is located, a higher rate of Medicare patients underwent balloon angioplasty in 2010 (10.3 patients per 1,000 Medicare beneficiaries) than did those in Tampa (7.1). The national rate was 7.5.

Hudson also had the highest rate (5.4) of surgery to remove the gallbladder due to gallstones, or cholecystectomy. The national rate was 3.3.

Bayonet Point spokesman Kurt Conover said the hospital hadn't seen a spike in cholecystectomies. He said a number of patients seen by primary care doctors at Bayonet Point end up going elsewhere for the procedure.

In a telephone call with reporters this week, researchers said they aren't saying the rates should necessarily be lower in any one community. But they said the variation in the rates suggests many patients aren't fully informed of all their options and might have chosen more conservative treatment.

When it comes to the quality and consistency of the information patients get, said author David Goodman, "it's a dismal picture out there."

The researchers had no clear answers about why one medical community might be more likely than another to push a certain elective procedure. Goodman said the rates didn't appear to be tied to the number of specialists in a community. For instance, a large number of orthopedic surgeons would not necessarily translate into a higher rate of hip and knee replacements, he said.

Goodman suggested the answer lies more in each community's "well-established patterns of practicing medicine." These cultures, he said, "are remarkably durable over time."

"It's very much an example that, at least to date, geography is destiny."

Researchers say they hope the lesson for both patients and their doctors is to move toward a model known as "shared decision-making," in which the patient receives a better presentation of the risk, and benefits, of choosing a more conservative option.

That decision-making might involve information packets that the patient can review at home and not the "pressure cooker" of the exam room, said Goodman.

The trick, they said, will be to developed standardized, unbiased presentations. Insurers might want tools that discourage patients from expensive treatment; surgical equipment manufacturers might want to nudge patients toward procedures that would benefit their bottom line.

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

Comments
Do not eat any romaine lettuce, the CDC warns

Do not eat any romaine lettuce, the CDC warns

Public health officials are now telling consumers to avoid all types of romaine lettuce because of an E. coli outbreak linked to the vegetable that has spread to at least 16 states and sickened at least 60 people, including eight inmates at an Alask...
Published: 04/20/18
Florida hits a milestone: More than 100,000 people are registered to use medical marijuana here

Florida hits a milestone: More than 100,000 people are registered to use medical marijuana here

Florida has hit a milestone of sorts as it slowly moves toward wider availability of medical marijuana.The number of patients in the state who are registered to use the substance has surpassed 100,000 for the first time, according to Florida Departme...
Published: 04/20/18
Florida Hospital Carrollwood spending $17.5 million to expand emergency department

Florida Hospital Carrollwood spending $17.5 million to expand emergency department

Florida Hospital Carrollwood is expanding its emergency department. The hospital, 7171 North Dale Mabry Highway in Tampa, is spending $17.5 million to add 15 new private treatment rooms, new pediatric rooms and waiting areas, and new technology, acco...
Published: 04/18/18
Barbara Bush’s end-of-life decision stirs debate over ‘comfort care’

Barbara Bush’s end-of-life decision stirs debate over ‘comfort care’

As she nears death at age 92, former first lady Barbara Bush’s announcement that she is seeking "comfort care" is shining a light — and stirring debate — on what it means to stop trying to fight terminal illness.Bush, the wife of former President Geo...
Published: 04/17/18
Preparing for the worst, staffers at Johns Hopkins All Children’s learn through simulation

Preparing for the worst, staffers at Johns Hopkins All Children’s learn through simulation

When the patient got violent, Dr. Michelle Hidalgo didn’t have time to think. She had to react. The woman was moving strangely and seemed erratic. Hidalgo had to make a tough call — it was time to physically restrain her for everyone’s safety.Then th...
Published: 04/16/18
Updated: 04/17/18

Lung cancer patients live longer with immune therapy

The odds of survival can greatly improve for people with the most common type of lung cancer if, along with the usual chemotherapy, they are also given a drug that activates the immune system, a major new study has shown.The findings should change me...
Published: 04/16/18
Thousands of pounds of prepackaged salad mixes may have been tainted with E. coli, officials say

Thousands of pounds of prepackaged salad mixes may have been tainted with E. coli, officials say

A Pennsylvania food manufacturer is recalling 8, 757 pounds of ready-to-eat salad products following an E. coli outbreak that has spread to several states and sickened dozens of people.Fresh food Manufacturing Co., based in Freedom, Pennsylvania, is ...
Published: 04/15/18
St. Anthony’s Cancer Center installs bell dedicated to survivors

St. Anthony’s Cancer Center installs bell dedicated to survivors

ST. PETERSBURGSister Mary McNally, vice president of mission at St. Anthony’s Hospital, stood in front of a room of cancer survivors to unveil a silver bell surrounded by butterfly stickers mounted to the wall of the Cancer Center lobby. "So often pe...
Published: 04/13/18
Hand dryers could leave your hands dirtier than you think

Hand dryers could leave your hands dirtier than you think

Washing your hands after you use the bathroom is a good idea. But using a public dryer could undo all that hard work, according to a new study.A study, published in the journal Applied and Environmental Microbiology, examined 36 men’s and women’s bat...
Published: 04/13/18
Meek and Mighty Triathlon draws the young (siblings who are 7, 9 and 11) and not so young

Meek and Mighty Triathlon draws the young (siblings who are 7, 9 and 11) and not so young

The annual St. Anthony’s Triathlon has for years attracted elite athletes from around the world, making the St. Petersburg race one of the premier triathlon events in the country. There’s a big incentive to run fast, swim hard and be the best on a bi...
Published: 04/13/18