NC can cut Medicaid costs without cutting dental care for old people

Yesterday the NC Senate released a budget proposal for NC Medicaid that saves money by cutting so-called “optional” Medicaid services for elderly and disabled people.  These “optional” services include dental care, physical and occupational therapy, respiratory therapy, nursing homes and eyeglasses.  Not exactly all that optional for most people.

Is this really the only way to save money in our Medicaid program?  Writing in the NYT today, Dr. Rita F. Redberg, a cardiologist and editor of the journal Archives of Internal Medicine, suggests five specific ways the federal Medicare program could save billions of dollars.  Basically she suggests ending taxpayer subsidy of treatment that has been clearly shown to be either ineffective or harmful.  She states:  “Of course, doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”

Why couldn’t NC Medicaid take the following suggestions from Dr. Redberg to heart to save money?  In fact, why not take just a few of these suggestions?  Here they are:

• Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure. Moreover, colonoscopies carry risks of serious complications (like perforations) and often lead to further unnecessary procedures (like biopsies). In 2009, Medicare paid doctors more than $100 million for nearly 550,000 screening colonoscopies; around 40 percent were for patients over 75.

• The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than $50 million in 2008 on such screenings, as well as additional money on unnecessary procedures that often follow.

• Two recent randomized trials found that patients receiving two popular procedures for vertebral fractures, kyphoplasty and vertebroplasty, experienced no more relief than those receiving a sham procedure. Besides being ineffective, these procedures carry considerable risks. Nevertheless, Medicare pays for 100,000 of these procedures a year, at a cost of around $1 billion.

• Multiple clinical trials have shown that cardiac stents are no more effective than drugs or lifestyle changes in preventing heart attacks or death. Although some studies have shown that stents provide short-term relief of chest pain, up to 30 percent of patients receiving stents have no chest pain to begin with, and thus derive no more benefit from this invasive procedure than from equally effective and far less expensive medicines. Risks associated with stent implantation, meanwhile, include exposure to radiation and to dyes that can damage the kidneys, and in rare cases, death from the stent itself. Yet one study estimated that Medicare spends $1.6 billion on drug-coated stents (the most common type of cardiac stents) annually.

• A recent study found that one-fifth of all implantable cardiac defibrillators were placed in patients who, according to clinical guidelines, will not benefit from them. But Medicare pays for them anyway, at a cost of $50,000 to $100,000 per device implantation