Doctors call for appropriateness criteria

A team of U.S. researchers say healthcare leaders and the medical community should develop evidence-based appropriateness criteria for elective procedures. Lead author Dr. Hassan M.K. Ghomrawi, assistant professor of public health at Weill Cornell and an outcomes research scientist at Hospital for Special Surgery, said currently, there were no appropriateness criteria for the most common elective procedures. Ghomrawi said total-joint-replacement surgeries -- such as hip and knee replacements -- were among the most common inpatient surgeries in the United States. Patients requesting joint-replacement surgery vary from those disabled by their joint arthritis to those who do so to maintain an active lifestyle without pain. Total-joint-replacement surgeries are expected to quadruple over the next two decades, contributing to the rise in U.S. healthcare costs and increasing the risk of medical complications. "The purpose behind establishing criteria is to use evidence-based metrics to prioritize patients most in need," Ghomrawi said in a statement. "We don't want to sacrifice necessary care when thinking of cost-containment." Experts predict the number of elective surgeries would grow drastically, exceeding 4 million by 2030, but these projections don't reflect the increase in the number of patients who will gain health insurance coverage when the Affordable Care Act is fully implemented in 2014. The article was published in The New England Journal of Medicine.