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Comment & Response
March 2014

Decrease the Incentives to Order Lipid Panels

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

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 This change reflected an alignment with evidence, rather than reliance on guidelines that might be flawed or out of date.

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