Blog | Thursday, August 14, 2014

One physician's take on ACP's CME offering about high value care

Today in my inbox I got a letter entitled “ACP addresses medical costs.” The American College of Physicians has, indeed, started to address medical costs, but this letter announced something quite wonderful. It was a free link (for ACP members only, unfortunately) to an online course that addresses some of the most needlessly expensive care that internists order. Although the course is not required, completing it not only gives me continuing medical education hours but maintenance of certification (MOC) points to maintain my internal medicine board certification.

Five years ago when I started writing this blog I proposed that in order to reduce health care spending in America physicians should be made aware of the cost of everything they order or prescribe and that they should be required to complete continuing medical education on cost effective medical care. Nobody read my blog back then, but apparently other people, namely the physicians of the ACP, must have figured this out on their own. Most patients don’t know that doctors are mostly unaware of medical costs. When they see their bills they probably just make the assumption that we are greedy and inconsiderate rather than gravely misinformed. It looks like one of internal medicine’s major organizations (ACP) has decided to do something about this.

Using fictional cases, they present itemized bills from hospitals and clinics and imaging centers, pointing out how we could make changes that would save patients money and risk, and giving some pointers on how to do our job more effectively. There was a testimonial about how medical bills affect a young, uninsured person’s life, which was entertaining because he was actually a comedian and the testimonial, though true, was part of his standup routine. His ruptured appendix cost $45,000. Ouch! The cases are followed by multiple choice questions. Did you know that 60% of all bankruptcy cases were due to medical bills? I chose 20%. That sounded bad enough. The right answer was 60%. Actually 62%, according to the discussion. Nearly 80% of those people had health insurance, so regardless of the effectiveness of the Affordable Care Act in reducing the number of uninsured, patients will still be hurting financially unless we change the way we practice. Other modules included data on how excess ordering of tests doesn’t reduce malpractice suits and how to deal with patients’ expectations for antibiotics for colds and MRIs for back pain. There were links to resources on medication costs and examples of the use of various risk calculators to help determine the best approach to common and alarming symptoms. Most of the information was not new to me, but enough of it was that the process was definitely worthwhile.

I just completed the 5-section module, which was interesting and probably mostly true. I learned all sorts of things, and if the majority of internists did the modules, I think there would be some noticeable behavior change, with corresponding humongous cost savings and improvement in care. I earned 13 maintenance of certification points for my internal medicine board certification, including the “patient safety” requirement, which I didn’t know existed, but clearly should exist. I don’t think I actually need the points since I just completed my board recertification last year, but it never hurts to have extra education.

It is my firm belief that physicians, when armed with adequate information about what things cost and how to use medications, testing and procedures more appropriately, will make changes in health care costs that will dwarf any savings related to high profile strategies like fraud prevention and cuts in physician reimbursement. The culture of medical care in the United States has been so far removed from considering costs that it will take some major shifts in the way we think for us to be good stewards of limited health care resources. I’m glad ACP is taking on issues of cost transparency and evidence based diagnosis and treatment and that they have produced such an interesting and painless education product to push that agenda.

Janice Boughton, MD, ACP Member, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.