HFMA ANI: Revamping doctor-patient relationship may be key to cutting unnecessary care

When Neel Shah, M.D., projected a slide containing a medical bill at last week's Healthcare Financial Management Association Annual National Institute in Orlando, Florida, he quipped that its 30 seconds of screen time is the longest a doctor ever looks at a medical bill.

Shah serves as executive director of Costs of Care, a not-for-profit organization with a mission of reducing patients' medical bills by looking at healthcare delivery in the United States holisitically. He discussed how to engage clinicians in delivery better value in healthcare.

According to Shah, academic studies have done a very good job of quantifying the fact that the U.S. healthcare system spends about $750 billion a year on unnecessary tests, procedures and other facets of care. But finding a way to actually eliminate such wasteful practices has not yet been truly investigated.

That's particularly challenging given the culture of U.S. healthcare delivery. Unlike the British single-payer system, which focuses on the needs of the average patient, Shah noted that the U.S. system is more vested in identifying more rare medical cases. As a result, costs are often dismissed because considering them may not be in the best interest of a patient. Shah, obstetrician by training, even noted in a recent interview with WBUR that American women might be better off having their children in Britain. In a subsequent interview, Shah suggested that the entire U.S. maternity care system could be reengineered.

Meanwhile, to patients, prices seem arbitrary, if not inflated. Their overall satisfaction scores with their care have not been stellar. Therefore, placing the issue clearly between patients and their physicians may be a workable aproach. Some other experts have suggested that nurses also can play a role in this dialogue if they are educated about the costs of healthcare delivery.

"There has to be a way, when you're trying to engage clinicians, to be very precise about the piece of wasteful healthcare spending that they own," Shah said. He added that there may be $100 billion that could be returned to the pockets of patients "just by making decisions differently."

Up to a third of all items on a medical bill can be replaced with other services that not only provide value for the patient, but cost less. "Physicians should own that," Shah said.

Among the things they can do: Stop ordering serial ultrasound tests. Stop ordering MRI scans for lower back pain. If an OBGYN is going to perform a hysterectomy, he or she has a choice of doing so with a $500 group of medical instruments, or a $2 million robot. One is a lot less expensive to use and the outcomes are identical.

To change behavior, doctors should have more cost information placed right in front of them. Shah quoted physician author Abraham Verghese, who said that if you're ordering off a menu without prices, you will choose the filet mignon every time.

The actual costs do not have to be published. Shah said simply having multiple dollar signs in front of a procedure on an electronic ordering system would be enough. "Zagat figured out four dollar signs is enough to pick the right restaurant," he said.

To learn more:
- read the WBUR article 
- check out the second WBUR article 
- visit the Costs of Care website

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