A small group of medical professionals here is planning to survey health-care providers to ask for examples of unnecessary tests and procedures, then urge the community to avoid them to improve the Spokane areas health-care system.


The group, the Regional Ethics Network of Eastern Washington, hopes that the dollars saved when patients forgo unnecessary tests and procedures would be redirected to strengthen the local health-care system, says Dr. William Bender, a member of the group. He says its hoped that an improved health-care system here could provide a compelling example for communities elsewhere to follow.


We will begin this project by attempting to solicit a list, from health-care providers in the region, of those medical procedures that they see as being pure waste, says Bender. We are not attempting to ration care, or limit controversial care. We want to identify those things that we do that no longer have a solid foundation, and are of no benefit to anyone.


For example, Bender, who is a neurologist, says that many headache sufferers undergo magnetic resonance imaging testsat a cost of $1,500 a testeven though in more than 99 percent of such cases theres nothing wrong inside their head. The finding of abnormality on those is less than 1 percent. I see five people a day who have had MRIs they never needed. Those patients are among any neurologists typical patient load, Bender says.


Everyone in medicine, Bender adds, knows of something they see being done that they know is a waste of time. Theres no doubt that theres a lot thats being done to avoid litigation.


Alan Sager, co-director of the Health Reform Project at the Boston University School of Public Health, has agreed to help the network here on the project. Sager has worked on widely quoted research reports on the U.S. health-care system, including one last year that said escalating health-care costs had eaten up 25 percent of all of the economic growth achieved in the U.S. in recent years.


What we advocated in the last 15 to 20 pages of our report is a bottom-up approach to squeezing out waste that is doctor driven, Sager said from his Boston-area office in a telephone interview last week. One of the main challenges is to do what Dr. Bender and his group are doing.


Efforts to curb health-care spending through price controls or regulation have failed, Sager said. We think doctors are crucial because their decisions control 87 percent of the health-care dollar, he said. He added that he will help the Spokane group in the gathering of information and in getting the results of its effort publishedand that he believes major insurers will react positively to the project.


Bender, the chairman of the ethics committee at Deaconess Medical Center here, says most of the other members of the Regional Ethics Network serve in similar positions. They include Dr. James Shaw, medical director of the Providence Center for Faith & Healing and an ethics consultant at Sacred Heart Medical Center; Rose Mary Volbrecht, a professor of philosophy at Gonzaga University and a member of the ethics committee at Holy Family Hospital; Judy Meyers, a member of the faculty at the Intercollegiate College of Nursing; Dr. Brian Budenholzer, of Group Health Cooperative; Sally Denton, administrator of St. Joseph Care Center; Dr. Don Cubberley, of Inland Imaging Associates PS; Dr. John Osborn, of the Veterans Administration Medical Center here; and Brent Stanyer, a Spokane attorney who practices health law and other types of law.


A solicitation letter that asks health-care providers for examples of wasteful practices will be published soon in an issue of the Spokane County Medical Societys monthly newsletter, which is sent to doctors, physicians assistants, and nurse practitioners, Bender says. He says hospitals also will be asked for examples of unnecessary tests and procedures.


Hes unsure how long it will take to get the kind of responses the group will need, and he doesnt know yet whether additional solicitations will have to be made.


After the Spokane group has received examples of wasteful practices, it will study medical literature to weigh whether those tests and procedures truly are unnecessary, he says.


The network will seek backing from the Spokane County Medical Society and the Washington State Medical Association to gain legal immunity for practitioners who stop performing tests and procedures deemed to be unnecessary.


Also, it will draft care guidelines for the community that reject wasteful steps.


We hope to ultimately get some buy-in from the community at large, so people can consider this when they make requests for their own health care, Bender says.


The network conducted an Internet search to see whether any other community had taken the same approach to cutting waste, and we couldnt see where any had.


Insurers reactions


Insurers efforts to address the nations health-care crisis largely have been limited to being restrictive when setting guidelines for payment for health-care procedures, Bender says. The Spokane group hopes to relieve them of having to make restrictive guidelines, he says.


Bender says he isnt sure what the form of the insurers response will take.


What we ultimately hope for is a reduction in premiums, he says. Bender adds that Sager, who among other things has worked on a study of the disproportionate closing of hospitals in minority and low-income communities, has suggested that the network here pick big-ticket items so it can document significant savings as it works to curb needless tests and procedures.


Bender hopes for a positive response from Spokane-area medical patients to the care guidelines the network plans to produce, and says such a reaction is necessary to make headway against the nations health-care challenges.


The average patient doesnt see the interconnectedness between whats being spent on their health care and the cost of goods and services in their community, Bender says. Health-care insurance is rising, and so is the cost of doing business. People need to see that interconnectedness.


Eliminating wasteful tests and procedures could produce large savings, Bender says. He says studies show that about $6,500 is spent per capita annually on health care in the U.S., and the Spokane metropolitan areas population of more than 400,000 residents suggests a total outlay of $2.6 billion a year here.


Studies also suggest that half of all health-care spending is wasted, Bender says. If up to 50 percent of this total dollar value in our area is wasted, or not producing better health outcomes, imagine what could be done if that money were infused back into the system for expanded and improved health care. If that ended up happening, the effort here could serve as a strong example for other communities, he says.


In my wildest dreams, if something like this goes well, youre going to make news, Bender says. He says he has hope that the effort will succeed in part because I think we have a fairly well-connected medical community in Spokane. He believes that it makes sense to launch such an effort on the local level, adding, Weve looked at health-care reform at the national and state level. Its just sort of floundering. Sager voiced similar views, saying, If were going to fix health care, its going to be from the bottom up.


The ethics network here had notable earlier success with its POLST project, through which it gained approval by medical institutions here of a standard form for physicians orders for life-sustaining treatment, Bender says.


The POLST form now is a statewide form and was just presented at the White House Conference on Aging for consideration as a form that could be used nationally, Bender says.