Wednesday, January 14, 2015

Healthcare costs should matter (even to business-adverse docs)

This morning, I had the privilege of attending a grand rounds lecture across town given by Dr. Chris Moriates titled "First Do No Harm: High Value Care From the Front Lines." Dr. Moriates is among the team at Costs of Care dedicated to "transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills."

Confession time: when I start hearing about finances in medicine, part of my brain tends to shut down. I usually find most everything "business" oriented dull and difficult to comprehend. I have no interest in getting an M.B.A. or even ever being an office medical director; budgets and dollars and numbers are simply not my forte. But bear with me, because even this cost- and budget-adverse physician found Dr. Moriates' presentation highly compelling and actionable.

His lecture centered on these key premises:

1. Tests or treatments that physicians order that do not help their patients' health contribute mightily to wasteful healthcare spending, on the order of around 210 billion U.S. $ a year. This spending not only hurts our country as a whole but hurts our individual patients.

2. Although there are many issues regarding health care costs that physicians don't have direct control over, we can choose to not order tests or treatments that the evidence base clearly tells us are not helpful or even harmful.

3. Just telling doctors what to do (or not) and showing them the evidence base to back it up, however, is insufficient to create meaningful change. Cultures and systems of care have to make it easier for us to choose the right thing than it is to choose the wrong (or even less-right) thing.

I often feel overwhelmed and powerless when it comes to the problems with health-care costs, especially as someone who is not naturally gifted at understanding business and finance. What can I, as just one individual doc, do to play my part in making this gargantuan problem better? Thankfully, a great resource exists to help me play my small part: the Choosing Wisely campaign.

The Choosing Wisely website provides lists of "Things Providers and Patients Should Question," which are divided by specialty. Each specialty has a list of 5 common practices that have a strong evidence base behind them that physicians should adopt in most circumstances.* You can find the list for Family Medicine here.

By incorporating the 5 Choosing Wisely recommendations for Family Medicine into my practice, I can help prevent patient harm and unnecessary healthcare spending. It feels good to know that I do have the power to make a difference after all! I appreciated how Dr. Moriates distilled these complex issues into simple, straightforward concepts that I can apply, both a family doc and a residency educator.

* of course, there are exceptions to every rule. Choosing Wisely isn't, as far as I can tell, advocating "cookie-cutter medicine." Hence the lists are things we should "question," not hard and fast rules. But, most of the time, our decisions should probably fall in line with the evidence base.


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