Have you heard of The Dartmouth Atlas? The Dartmouth Atlas is an intriguing report released out of Dartmouth College in order to improve health care. The report analyzes health care spending and usage in different areas of the country picking up on regional trends. Last week, The Dartmouth Atlas published an interesting report revealing that prescribing practices among medical providers are vastly different depending on where they practice. Why?
Upon seeing the surprising regional variation in prescribing trends among health care providers, researchers naturally believed most of this fluctuation must be related to the health status of different communities. Perhaps residents of Miami, Florida whose Medicare beneficiaries filled an average of 63 prescriptions each year require more medications than Medicare beneficiaries living in Colorado who fill just 39 prescriptions each year on average because they aren’t as healthy. Individuals living in unhealthy areas of the country naturally require more prescription medications than those living in states with higher levels of wellness, right?
Some of the variation in prescribing behavior is attributed to the relative health of a region. However, researchers found health status only accounted for 31 percent of the differences in prescribing trends. The remainder of this regional variation falls on health care providers and the broken business model of our health care system.
Unlike most industries, it is well documented that in health care, supply drives demand. The more doctors, nurse practitioners and physician assistants practicing in any given region, the more office visits, medical tests and prescriptions that are ordered. The needs of patients aren’t the overall driver in how medical care is provided, but rather the supply of health care providers and availability of medical services.
In contrast to most other business models, in health care the consumer doesn’t pay directly. Instead, insurance companies are involved. This means that patients are less likely to ask if the medications they are prescribed are really necessary. After all, they are only paying for a small portion of the cost. With prescription drugs having less of an affect on patient’s wallets because they are processed through insurance, unnecessary or less needed prescriptions are filled without much thought.
Finally, medical training varies by region. Some medical schools and nurse practitioner programs take a more liberal approach to prescribing medications while others lean more toward teaching preventative care. Ultimately, the way medical providers are trained carries over into how they practice. Providers who studied at institutions with high rates of prescribing bring this approach to medicine with them into their careers.
The findings of The Dartmouth Atlas study pose a major problem. They show that in some regions providers are overprescribing medications to patients. By overprescribing medications, these providers put patients at risk and inflate medical costs. Prescribing unnecessary medications increases the risk of drug interactions and puts patients at risk for experiencing negative drug side effects. Not to mention, overprescribing means patients are spending more than necessary on medical bills. For example, in Miami the average Medicare beneficiary spends $4,738 on prescription drugs each year compared to the national average of $2,968.
As medical providers, it’s important that we ask ourselves which medications are really necessary for our patients. When a non-pharmacologic alternative exists for a medical problem, we must take the time to explain this to our patients giving them options for their treatment. Awareness of our own prescribing habits and educating our patients about alternative treatments where they exist will help bring much needed consistency to prescribing habits across the country.
If you have practiced in different regions of the country, have you noticed variations in prescribing practices between locations?