1. you are the one trying to make an argument to affect what efficiency experts are touting. I gave a warning of what not to try when an "efficiency expert" denies one of your requested procedures.
2. EKGs and CXR are not big cost generators - for you.
when I was in ER, the big push by the hospital was to document the initial read of xrays and EKGs, because that was lost money.
the average cost of an EKG is $800 (higher than an epidural hmm...). at minimum, at least 1.5 million people are admitted to the hospitals in the US with "Acute Coronary Syndrome". admittedly "funny math", but its quite possible that at least $1.2 billion are spent on these admission EKGs alone. factor in the other 3.5 million people who are seen in ER for chest pain, outpatient studies, etc.
yet oddly, I have not seen a single lawsuit stating that an EKG shouldn't have been done. (and also fyi, physician fee in the read averages $50-100).
3. imho, your reports only heighten the awareness of how poor the literature is out there to support interventional pain medicine.
4. most of the lay public really believe that caths, stents, angioplasty, etc. are necessary to save lives. they put IPM at a lower level. if the lay public really believes that these "lifesaving" procedures are worthless, what will they think of procedures that are of potentially equal low quality evidence that aren't lifesaving?
I would favor having an honest discussion on IPM and highlighting studies that are good quality, with hopefully favorable results, rather than attack and distract.
whatever. clearly you disagree, so cool beans to you, bro.
1) I am clearly showing the absurdity of these "experts" being applied across VARIOUS medical specialities. I thought my analysis was pretty clear but I guess not considering you continue to miss it and add strawman arguments.
2) I am sure there will be questioning of EKGs being needed in the future if the costs go up too much (just like MRI for back pain, CTs of headaches, etc)
3) By that logic, the literature is "poor" for all of procedural medicine not just IPM if you want to argue only long term level 1 evidence based medicine "efficacy". There are zero LONG term studies showing the efficacy of most of orthopedics, interventional cardiology, etc over "years" of time in the vast majority of patients treated.
However, I disagree with the end point parameters and how efficiency experts determine "short term" relief for IPM.
For instance, no one has EVER argued a simple LESI will cure someone for "years" and make them run marathons. Apparently, that is basically the standard guy's like Chou are determining to be "clinically significant".
Why would an LESI for instance that can help for 3 months in 60% of patients with a disc herniation not be "significant"? If these patients are helped into a rehabilitation program that they weren't able to do previously (huge number of patients I see), why not use this method? Its another "tool" in the toolbox.
Considering 60-70% of disc herniations can resorb themselves, the LESI should be considered an adjuvant procedure that helps along this process. IPM should only be practiced in a multidisciplinary fashion without being either a needle shop or a pill mill.
The other question is if we don't use IPM, what are the alternatives?
Well, according to Chou, its massage/Chiropractic/Acupuncture/Yoga. The problem is Chiropractic "care" never ends EITHER and can costs thousands per year (I know because most of my patients have previously gone through Chiropractic care in the past)
Acupuncture will often cost 90 dollars/15 min session and will need MANY sessions on a chronic basis. If an LESI is "short term" in terms of benefit, acupuncture is SUPER short term comparatively.
Mind you, most of my patients have done MANY of these modalities before coming to our group and we NEVER lack for patients.
The other alternative is more fusion surgery at >50-100K/pop without complications.
Or we have can have these patients flood the ER at 1000 visit WITHOUT imaging costs.
Not as simple as Chou makes it out to be with some staged and isolated "analysis"
4) Most of the "lay public" has been fooled if they think stents are "life saving procedures" in the vast majority of cases they are implanted. This is why I posted that ONCOLOGIST TWITTER account who clearly shows that it is dishonest for the cardiologists to present STENTS this way.
Where is the evidence of this "life saving" effect?
STENTS have zero evidence for mortality benefit in HUGE RCT trials that have tracked them now for >10 years in literally 10s of thousands of patients in the COURAGE study.
Also, considering the complication rates of STENTS are FAR HIGHER than that of medication management with similar benefit, you can argue that STENTS are literally causing far more harm than good.
Also, by that logic, most of Orthopedics offers procedures with very "weak" evidence by RCTs over a long term period (>1 year) for the vast majority of patients for "diseases that aren't deadly" either.
Please name ANY RCTs that show TKR are beneficial for >1 year out for the VAST MAJORITY of patients they are done on in the USA?