The federal government requires preoperative testing before cataract surgery, which costs the healthcare system $500 million annually — but has no positive effect on patient health, according to a blog post in The Wall Street Journal.
Peter Pronovost, MD, senior vice president with Baltimore-based Johns Hopkins Medicine and director of the Armstrong Institute for Patient Safety and Quality, wrote the piece published earlier this month.
He cites a 17-year-old study in The New England Journal of Medicine that found preoperative medical testing before cataract surgery "does not measurably increase the safety of the surgery." Dr. Pronovost and his colleague Oliver Schein, MD, an ophthalmologist, also wrote a study titled, "A Preoperative Medical History and Physical Should Not Be a Requirement for All Cataract Patients," published in the Journal of General Internal Medicine in March.
Despite robust data supporting this conclusion, the tests "continue to be required by the federal government and accrediting organizations before every cataract surgery and other low-risk elective procedures," Dr. Pronovost writes.
Instead of performing the costly tests on every cataract patient, those who need it can be identified with a checklist, he notes.
Dr. Pronovost writes the requirement may not be the only regulation that could be revamped or scrapped entirely without jeopardizing patient safety. For instance, CMS recently eliminated a regulation preventing nutritionists from writing diet orders.
"Wise regulations have accomplished much good in healthcare," he concludes. "Still, CMS should establish a process to identify, evaluate and revise or remove regulations that corset clinicians, increase costs and place burdens on patients without clear benefits to safety or quality."