NOTE: The new law provides for the creation this year of a nonprofit corporation, the Patient-Centered Outcomes Research Institute, which would conduct research comparing the clinical effectiveness of medical treatments. The institute’s findings could not be construed as mandates, though, or used to deny coverage.

... But Allow for Expertise

“Government policy often results in a race to the average and mediocre, to the customary and usual, while ignoring the exceptional and extraordinary. And it is this group of patients — the unusual, the outlier, the complex, the group that has failed evidence-based care — that represents the costliest group in any illness category. Such is the case in migraine, where a very small percentage of patients represent 75 percent of the overall costs. These are the patients who must be hospitalized, who attend the emergency department on a regular basis, who develop secondary illness, undergo needless procedures and surgery, and become dependent on narcotics in their desperate search for pain relief. The pursuit of savings by government agencies often misses the point that good care at almost any price is less costly than bad care at almost any savings.”

Joel R. Saper, M.D., founder and director, Michigan Head Pain & Neurological Institute, Ann Arbor, Mich.

Use ‘Integrative Medicine’

“Plenty of studies now show that integrative medicine works very well. By that I mean the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, and has a broader scope that includes therapies from conventional bioscientific medicine, as well as newer complementary approaches like acupuncture and chiropractic. For example, a study conducted at Mount Sinai School of Medicine in New York found that when women participated in a hypnosis session before breast surgery, they required less pain medication and experienced less nausea and emotional upset than the control group. Patients in the hypnosis group also cost the hospital $772 less overall. That’s an example of how a simple technique can help patients and reduce costs.”

Woodson Merrell, M.D., chairman, department of integrative medicine at Beth Israel Medical Center, New York

Pay to Treat Child Obesity

“We struggle constantly to get reimbursement for services at my clinic. This is terribly short-sighted. Society could spend one thousand dollars now for comprehensive medical care for an obese child, or it could spend one hundred thousand dollars later for that patient’s coronary artery bypass surgery. Every insurance company figures it’s not their problem: an obese kid will likely be with a different carrier by the time he or she starts to experience costly health complications.”

David Ludwig, M.D., director, Optimal Weight for Life Program, Children’s Hospital, Boston

Stop Overtreating