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Comment & Response |

Decrease the Incentives to Order Lipid Panels

Mark McConnell, MD1; John R. Downs, MD2; Chester B. Good, MD, MPH3
[+] Author Affiliations
1Tomah VA Medical Center, Tomah, Wisconsin
2South Texas Veterans Healthcare System, University of Texas Health Science Center, San Antonio
3VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Intern Med. 2014;174(3):473. doi:10.1001/jamainternmed.2013.12872.
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To the Editor Reduction in unnecessary consumption of resources is critical to health care in the United States.1 Therefore, we applaud the investigation of excess lipid testing by Virani et al.2 We suggest taking this a step further by asking why we check lipid levels: is our goal to lower low-density lipoprotein cholesterol (LDL-C) level or to help estimate a patient’s risk of bad outcomes? While many argue that both are important goals, an ever-increasing minority posit that the latter should be the area of our focus.3,4 In 2011, the Department of Veterans Affairs (VA) formally recognized that patients with heart disease and/or diabetes who are taking a moderate-dose statin are getting optimal risk management based on high-quality evidence, and they modified their performance metric accordingly. This change reflected an alignment with evidence, rather than reliance on guidelines that might be flawed or out of date.

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March 1, 2014
Salim S. Virani, MD, PhD; Christie M. Ballantyne, MD; Laura A. Petersen, MD, MPH
1Health Policy, Quality, and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas3Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas4Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
3Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas4Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
1Health Policy, Quality, and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
JAMA Intern Med. 2014;174(3):473-474. doi:10.1001/jamainternmed.2013.12842.
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