It was a tough winter. Healthcare reform launched inauspiciously. Questions were raised (by a RAND Corp. report released in early March) about the promise of value-based purchasing to improve care and lower costs. The weather was lousy. And the Chicago Bulls (my local team) lost Derrick Rose for a second season because of an injury – this time, his right knee.
But there were bright spots. One I’d like to draw your attention to is the release of a series of “High Value Care” case studies from the American College of Physicians, intended to help clinicians understand the benefits, harms and costs of tests and treatment options for common clinical issues, so they can pursue care that improves health and eliminates wasteful practices. (Those are ACP’s words, not mine.)
“Doctors and other healthcare professionals can use these case studies to learn how to balance the clinical benefits of diagnostic and treatment options with harms and costs, with the goal of improving patient outcomes,” Cynthia D. Smith, MD, FACP, ACP’s senior physician educator, was quoted as saying.
The interactive case studies offer clinicians the opportunity to earn free continuing medical education credits and ABIM Medical Knowledge (MOC) points, and cover the following five topics:
- Avoid unnecessary testing.
- Use emergency and hospital level care judiciously.
- Improve outcomes with health promotion and disease prevention.
- Prescribe medications safely and cost-effectively.
- Overcome barriers to High Value Care.
The Journal of Healthcare Contracting has reported on “Choosing Wisely,” an initiative of physician specialty societies that identifies tests and procedures that are commonly used, but not always necessary. And we hope you caught last year’s Executive Interview with Susan Skochelak, MD, the American Medical Association’s group vice president for medical education, who told us that tomorrow’s physicians are going to have a deeper understanding than their predecessors of the financial impact of their decisions.
Balancing the effectiveness and cost of clinical decisions is good news for contracting executives…and for the U.S. healthcare system. We all know the significant barriers that stand in the way, including fears of malpractice as well as the desire by physicians to do everything they possibly can for the good of their patients.
And yes, a study published in the January 2014 issue of Health Affairs showed that among 503 orthopedic attending physicians and residents at seven academic medical centers, just 21 percent of the attending physicians correctly estimated the cost of commonly used orthopedic devices, and just 17 percent of the residents did so.
However, more than 80 percent of those physicians and residents said that cost should be “moderately,” “very” or “extremely” important in the device selection process.
With all this going on, we have cause for hope that doors will open for more constructive dialogue between physicians and contracting executives.