Flip side of innovation: What causes doctors to scale back on the use of medical practices

November 27, 2017, The Dartmouth Institute for Health Policy & Clinical Practice

All countries face the challenge of funding ever-new and expensive treatments, with increasing pressure on budgets, harmful deficit spending, and ever-higher health insurance premiums. One solution to these concerns is to scale back on outdated or low-value procedures; not unlike clearing out one's clothing closet to make room for more contemporary wear.

Yet there is little understanding of "exnovation," or the scaling-back of expensive medical treatments for certain medical practices. To better understand this process, researchers at The Dartmouth Institute for Health Policy and Clinical Practice studied nearly 10,000 physicians who performed —a surgical used to reduce the risk of stroke by correcting narrowing in the carotid artery—on elderly Medicare patients between 2006-2013. Its use is increasingly controversial, particularly among older patients and for those who aren't exhibiting symptoms of carotid artery narrowing.

In the study, recently published in the BMJ, the researchers found, consistent with other evidence, a declining trending in the rate of carotid revascularization nationally from 2006 to 2013. Yet the decline was by no means consistent across different types of physicians; those with more than 25 years of experience were likely to cut back on their use of carotid revascularization more rapidly than those with less experience. Also, vascular surgeons and thoracic surgeons who had the largest practice share of carotid revascularization were far less likely to reduce their use of the procedure compared with physicians from other interventional specialties. Finally, despite evidence that both patients older than 80 and those without symptoms tend not to benefit from carotid revascularization, the researchers did not find higher rates of decline among these patients.

"As we try to reduce the use of low-value care (care that doesn't benefit or can harm ) it's important that we get a much better understanding of the factors that affect a physician's decision to scale back on procedures that might no longer be the most effective, or at least the most effective for certain patient populations," said lead author and Dartmouth Institute Assistant Professor Kimon Bekelis, MD.

"I'd say the study suggests that in the U.S., we're not doing a good job of cleaning out the closet of those moth-eaten sweaters, so to speak, and that we need to do a better job to ensure that there's plenty of fiscal space for the new and valuable innovations appearing in the coming years," added co-author Dartmouth Institute health economist Jonathan Skinner, PhD.

Explore further: Better clinical care may contribute to fewer carotid artery surgeries

More information: Kimon Bekelis et al, De-adoption and exnovation in the use of carotid revascularization: retrospective cohort study, BMJ (2017). DOI: 10.1136/bmj.j4695

Related Stories

Better clinical care may contribute to fewer carotid artery surgeries

September 21, 2017
A nationwide study that reviewed 16 years of Medicare beneficiary data showed a steady reduction in carotid endarterectomy – the surgical procedure used to remove plaque built up inside a carotid artery.

Almost one in 10 readmitted after carotid revascularization

April 10, 2015
(HealthDay)—Almost one in 10 Medicare patients undergoing carotid revascularization are readmitted within 30 days, according to a study published in the April 14 issue of the Journal of the American College of Cardiology.

Why do older asymptomatic patients have carotid imaging

April 18, 2016
Most of the patients who had carotid revascularization for asymptomatic carotid disease were diagnosed on the basis of carotid imaging tests ordered for uncertain or inappropriate indications, according to a new study published ...

Cerebrovascular reserve-based strategy is cost-effective

January 29, 2015
(HealthDay)—A decision rule based on assessment of cerebrovascular reserve (CVR) seems to be cost-effective for prevention of stroke in asymptomatic patients with carotid artery stenosis, according to a study published ...

Researchers study outcomes of carotid artery stenting following prior carotid procedure

November 14, 2011
A new study shows that carotid artery stenting (CAS) following prior same-side carotid artery revascularization is safe, effective and results in lower incidences of in-hospital death, stroke and heart attack compared to ...

Study finds patients more likely to receive surgical intervention for narrowed arteries in fee-for-service

March 1, 2017
Individuals were more likely to undergo surgery to treat narrowed arteries when they were treated by fee-for-service physicians in the private sector compared with salary-based military physicians, according to a study published ...

Recommended for you

A co-worker's rudeness can affect your sleep—and your partner's, study finds

December 14, 2018
Rudeness. Sarcastic comments. Demeaning language. Interrupting or talking over someone in a meeting. Workplace incivilities such as these are becoming increasingly common, and a new study from Portland State University and ...

A holiday gift to primary care doctors: Proof of their time crunch

December 14, 2018
The average primary care doctor needs to work six more hours a day than they already do, in order to make sure their patients get all the preventive and early-detection care they want and deserve, a new study finds.

Teens get more sleep with later school start time, researchers find

December 12, 2018
When Seattle Public Schools announced that it would reorganize school start times across the district for the fall of 2016, the massive undertaking took more than a year to deploy. Elementary schools started earlier, while ...

Large restaurant portions a global problem, study finds

December 12, 2018
A new multi-country study finds that large, high-calorie portion sizes in fast food and full service restaurants is not a problem unique to the United States. An international team of researchers found that 94 percent of ...

Receiving genetic information can change risk

December 11, 2018
Millions of people in the United States alone have submitted their DNA for analysis and received information that not only predicts their risk for disease but, it turns out, in some cases might also have influenced that risk, ...

Yes please to yoghurt and cheese: The new improved Mediterranean diet

December 11, 2018
Thousands of Australians can take heart as new research from the University of South Australia shows a dairy-enhanced Mediterranean diet will significantly increase health outcomes for those at risk of cardiovascular disease ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.