In an ideal healthcare world, clinical practice should drive reimbursement, not the other way around. By saying that, I mean that the powers that be should think about paying for tests and treatments that work, and not paying for those that demonstrate little value. Particularly when it comes to vestibular patients, and I am sure true of many other patients as well, it seems we have fallen into the rabbit hole of fiscal insanity.
We have all heard on the news that the current health care system promotes over-testing and treatment, and that we need to start focusing our healthcare dollars on more evidence-based management. It seems that some practitioners do procedures that are profitable, whether they work or not, and don’t do procedures that pay poorly, whether they work or not. Yes, this is an overstatement, but there is a lot of truth to it. It is simply an example of reimbursement driving clinical practice.
The Swedish study discussed over the past few weeks supports my long-held belief that vestibular clinics are extremely cost-effective, particularly when compared to the most common diagnostic approach (imaging or observation) and treatment offered (meclizine). Yet, vestibular tests have been devalued to the point that Medicare’s fee schedule no longer covers the cost of providing comprehensive vestibular evaluation and management. What does that leave? Come back next week for an example of how this can turn out badly.