Self-Funded 21% Of Medical Care Is Unnecessary. Here’s How We Prevent It.
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Dec 16, 2025 Will Bruhn, CEO and co-founder of Global Appropriateness Measures, sheds light on a shocking statistic: 21% of medical care is unnecessary. He discusses how traditional quality metrics focus too much on outcomes rather than appropriateness, leading to wasteful practices in healthcare. Real-world examples, like unnecessary spinal fusions and the surge in Friday afternoon C-sections, reveal financial incentives at play. Will also outlines how data can steer patients towards high-value care, ultimately aiming to eliminate this wasteful spending.
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Spine Surgery Shows Perverse Incentives
- One-third of spine surgeries are unnecessary; financial incentives drive fusions over simpler laminectomies.
- Two neighboring surgeons can have vastly different fusion rates and a $50,000 average cost gap per operation.
Friday C-Section Spike Reveals Convenience Bias
- GAM's research found C-section rates spike on Friday afternoons, suggesting convenience drives some surgical decisions.
- Will interprets this as physicians scheduling C-sections to avoid unpredictable weekend calls.
Appropriateness Metrics Can Reveal Fraud
- About a third of GAM's measures flag behavior bordering on fraud or abuse when providers are extreme outliers.
- GAM has supported DOJ and litigation efforts by providing provider-level appropriateness data.
