It might be easy to forget that reworking the health care system is about more than changing care reimbursement and expanding health insurance coverage.
Health care practitioners also are looking at the actual care they provide to try to find inefficiencies, save the system money and reduce the emotional and physical burden on patients.
The industry has already found success in selected areas, such as by reducing elective inductions of labor, which in the process improves outcomes and has the side benefit of saving money. Just today, a study indicated that annual mammography screening is not worth performing. And despite some criticism from a New England Journal of Medicine article, the ABIM Foundation's Choosing Wisely campaign has been finding success in its targeting of unnecessary or overused procedures.
Now, a common breast cancer procedure is the target of officials for two medical societies who have decided it is essentially unnecessary in a large number of cases.
The Society of Surgical Oncology with assistance from the American Society of Radiation Oncology released guidelines for a breast cancer lumpectomy follow-up procedure in which additional tissue is removed to achieve an adequate margin to prevent regrowth of the cancer.
"The reason we created this guideline is that there never has been a guideline about margin width for lumpectomy, and it is a very, very common operation," says Monica Morrow, M.D., a breast cancer surgeon who is immediate past president of the surgical oncology society.
Close to 25 percent of women having a lumpectomy have a second surgery, national studies have indicated, says Morrow, who is chief of breast surgery at Memorial Sloan Kettering Cancer Center. And in half of those cases, the second surgery was never necessary, because the cancer was not in a part of the tissue that would warrant it.
As a matter of practice, many surgeons removed additional tissue if the margin between the tissue and the cancer was not of a certain width. "The surgeons believe getting a bigger piece of normal breast tissue would reduce the risk of cancer coming back," Morrow says.
The idea derives from the time before chemotherapy and radiation became as effective as it has become. Those therapies typically would be provided in most of those cases, and would be sufficient treatment, meaning there's no scientific basis for the surgery, according to the societies.
Morrow says the adoption of the guidelines is not predominantly about reducing the risk of surgery, which has a low complication rate. "The important thing it reduces is stress and anxieties for patients and their families, and it reduces the cost of delivering care," Morrow says.
That sounds like a no-brainer in this era of tight finances and increased emphasis on patient-centered care.