Through a study supported by a FAER Research Fellowship Grant, Catherine L. Chen, MD, MPH, Resident Physician, Research Scholar, Department of Anesthesia and Perioperative Care, University of California San Francisco, examined unnecessary preoperative testing before cataract surgery, which is the safest and most common elective surgery among Medicare patients. The study assessed physician adherence to preoperative testing guidelines, examined costs from potentially unnecessary testing and aimed to “identify patient and health system characteristics associated with potentially unnecessary testing.” The results of the study were published in the New England Journal of Medicine.
“This research sheds light on preoperative testing and how we might improve care in the future,” J.P. Abenstein, MSEE, MD, President of the American Society of Anesthesiologists, said in an ASA news release about the study. “We know that over-testing is expensive, but it can also be harmful if it leads to overtreatment or causes complications. FAER and Dr. Chen should be commended for their important work on this topic.”
Dr. Chen’s study not only has significance to helping reduce Medicare spending while maintaining health care quality. It also holds importance to anesthesiology as a medical specialty and to Dr. Chen’s own academic career development, an important aspect of FAER grant funding.
Importance to Health Care Delivery and Quality
“Our study shows that routine preoperative testing still occurs in Medicare patients undergoing cataract surgery, one of the safest surgical procedures being performed today,” Dr. Chen said. “This testing continues even though the major professional societies have agreed for more than a decade that routine testing doesn’t improve outcomes from this surgery. Therefore, Medicare spending on routine preoperative testing in cataract patients is an area in which we can safely cut costs without compromising on health care quality.”
One compelling finding was that preoperative testing varied widely among physicians. It was more strongly associated with an individual physician’s practice patterns rather than patient characteristics such as age or illnesses. “Payers like Medicare could use this study to potentially target any interventions to the groups of physicians who are ordering more tests, rather than all physicians across the board,” she said. “However, I hope this study will encourage physicians to examine their own practice and spur behavior change from within, rather than in response to external forces.”
Importance to Anesthesiology
Anesthesiologists not only have an important role on the care team for cataract surgery, but also in the research being done to improve surgical outcomes and reduce costs.
“This study serves as an example of how anesthesiologists can use health services research to contribute to the conversation about maintaining high quality healthcare while reigning in unnecessary healthcare spending,” Dr. Chen said. “In addition to the specific findings related to preoperative testing in cataract surgery patients, I hope readers will appreciate that there are opportunities to use administrative data beyond just the descriptive studies you typically see. … These findings have practical implications and can have an immediate impact on the way we care for our patients.”
Importance to Academic Career Development
“The FAER Research Fellowship Grant was one of the keys to my early success, especially because I was able to obtain this grant while I was still a resident,” says Dr. Chen, who plans to stay at UCSF as a T-32 post-doctoral fellow after completing her residency. “The FAER grant covered all the costs to purchase the Medicare dataset and the statistical consulting services I used to complete this research study. I definitely would not have been able to publish my results in such a prestigious journal if I had not had the financial support from FAER to pursue my research in the first place.”