Barriers to ‘de-innovation,’ Diane Meier on the medical-industrial complex, & how regional variation affects patients

February 5, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page. 



In this month’s Health Affairs, Peter Ubel and David Asch take on the important challenge of “de-innovation”: the removal from medical practice of technologies and practices that have been replaced by better technologies or proven ineffective. Eliminating ineffective and unsafe procedures is essential to providing high-quality, high-value medical care. But a number of systemic and cognitive biases make the process of de-innovation a slow one. Aspects of physicians’ experiences, such as seeing patients with more severe forms of disease, or believing that procedures they perform are more beneficial than the evidence indicates, can make it hard to accept evidence of ineffectiveness and impede de-adoption. The existence of widespread cognitive biases makes the task of reducing low-value care more difficult, but no less important. Ubel and Asch lay out a few steps for overcoming those biases.


“The driving principle of medicine is revenue generation,” says Diane Meier, MD, who directs the Center to Advance Palliative Care at Mount Sinai Health System. Like many, she is angered by the “medical-industrial complex,” that doesn’t focus on patients first. As a keynote speaker at the Lown annual conference next month in San Diego, she is hopeful that the move away from fee for service will provide opportunities to improve healthcare. “We need a balance in healthcare. We need greater population health, more patient-focused care, decreased spending on healthcare and protection from overtreatment and under-treatment,” she says. Want to hear more from Meier? Read the interview and register for the conference now.


This week, Elisabeth Rosenthal, in the New York Times, gives a rare glimpse of the patient-level effects of regional variation in medical treatment. Elderly​ patients who migrate south for the winter​ often find themselves in areas with higher resource utilization and higher-intensity treatment patterns​ than their hometowns. There​, the patients wonder why their new doctors are recommending tests and treatments that their doctors back home have never suggested. Patients are left to choose between their trusted doctors back home ​and​ the new doctors who claim that their recommendations might actually save their lives. Or are the new doctors simply pushing an unneeded treatment?


QUESTION: Have you ever had a test or treatment recommended by a physician that your trusted clinician didn’t recommend? How did you handle that disconnect? Please share your comments in our discussion section at the bottom of this page.


We mourn the loss of Dusan Kocovic, MD, one of Dr. Bernard Lown’s fellows, who died on September 26, 2014. Dr. Kocovic cared for thousands of patients with complex rhythm problems and was known for his kindness and consideration. He is survived by his loving wife, Biljana, and a daughter, Jelena and son, Nikola.



  • We welcome the placement of nonprofit organizations’ informational materials at our exhibit table at the Third Annual Lown Institute Conference, March 8-11 in San Diego. If you would like to reserve space, please contact


  • California Association of Physician Groups will hold their annual meeting, Accountable Care: Accelerating the Evolution, June 11-14, at the Grand Hyatt Hotel, San Diego.  The conference will help physician groups to understand and thrive amid the rapid change of healthcare reform. For more information:



Mental health


End-of-life and advanced illness care


Patient safety


Population health


Anti-vaccine movement




Care transitions


Medical evidence


Healthcare quality




Precision medicine


Payment system


Patient decision making


Medical education and certification


Practice patterns


RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation