Providers must exercise 'good stewardship' in cost-care balancing act

It's a delicate balance between providing effective clinical care and considering costs. With a national spotlight on healthcare costs and unnecessary tests and procedures, providers must offer appropriate care, while keeping an eye on money.

In doing so, the American Medical Association advises physicians to exercise "wise stewardship" when making patient care decisions, FiercePracticeManagement reported.

In April, nine specialty societies released lists of overused tests and procedures without necessarily benefiting patients (or the healthcare system), such as CT scans or antibiotics for chronic sinusitis or routine cancer screenings for dialysis patients with short-life expectancies or no symptoms of cancer. In addition to the nine specialty societies, 11 more societies are scheduled to participate in ABIM Foundation's Choosing Wisely by the year's end, Managed Healthcare Executive reported.

Providers traditionally have been hesitant to limit overuse, viewing the approach as rationing care or restricting physicians in their diagnosis and treatment of patients, Managed Healthcare Executive noted.

"It's not saying to never do the things on this list or somebody else's list. It's just the things to think a little bit harder about," Paul Larson, M.D., member of the board of chancellors for the American College of Radiology, who helped form the list of recommendations for his specialty, told FiercePracticeManagement in an interview.

Waste makes up 30 percent of the nation's total healthcare bill--$750 billion--each year, according to Stephen Smith, Brown University professor and treasurer of the National Physicians Alliance.

"We had a culture, a set of beliefs in medicine, which was fine for most of the 20th century. But it's unsustainable, and it's not providing us with the benefits of more assurance of good health for our patients and our society," Smith said. "So, when the data no longer fit, you've got to shift the model. And, I think all these other things--the ACOs and bundled payments--are all reflecting the need to rethink the model of care that we have."

For more information:
- read the Managed Healthcare Executive article
- see the Choosing Wisely statement (.pdf)

Related Articles:
Cost considerations, effective clinical care at odds
Doc groups pinpoint top sources of unnecessary care
Interview: Physicians need to make time to discuss unnecessary care
High healthcare spenders don't deliver more unnecessary care
Study: Mammograms often lead to cancer overdiagnosis

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