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Getting bossy with doctors for cheaper treatment

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Kai Ryssdal: Here’s today’s health care conundrum. You walk into one hospital with clogged arteries and you’ll walk out with a prescription for Lipitor and instructions for a healthier diet. Walk into a different hospital — same clogged arteries, but a different town — and you’re more likely to end up on an operating table having a stent put into your heart. Both procedures tackle the problem, but one is a whole lot cheaper and safer, too.

From the Marketplace Health Desk at WHYY in Philadelphia, Gregory Warner explains the deciding factor.

Gregory Warner: The biggest difference between those towns, according to a study out this week, may be the number of surgeons. Marianne Udow-Phillips is director of the Center for Healthcare Research & Transformation at the University of Michigan. She studied five million insurance records across the state of Michigan. She says Michiganders are more likely to get elective surgery if they live in an area with a lot of cath labs — staffed with cardiologists and nurses trained in stenting.

Marianne Udow-Phillips: It’s not that it’s a wrong procedure it just may not be a necessary procedure, but there’s a financial motivation to fill those cath labs and get them used.

But sometimes those powerful financial incentives hit a roadblock at the corner office. CEOs and hospital boards, Udow-Phillps says, can play a huge role in changing doctor behavior. Oakwood Hospital in Dearborn went from having one of the highest rates of elective surgery to one of the lowest.

Udow-Phillips: After we published our study 10 years ago, the CEO of the hospital gave the study to the new chief of medical staff and said, fix this.

Actually he might have said:

Samir Dabbous: Do something about it.

Dr. Samir Dabbous is director of cardiology at Oakwood.

Dabbous: I sit every morning and I review every cath done the day before. Make sure there are no unnecessary procedures.

And here’s what he says to cardiologists complain that he’s killing their income.

Dabbous: You drop your income or you lose it altogether! You shape up or just take a hike!

And because old habits die hard, some doctors have taken him up on that offer.

In Philadelphia, I’m Gregory Warner for Marketplace.

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