Print Email

Value added care

 , August 07, 2013

Making the Case for Bottom Line Summaries

The nation is facing a crisis, at least partly, due to the rising cost of health care.  There are many factors contributing to this increase in cost, like the increasing burden of chronic conditions in the population.  Since physicians make most of the decisions regarding tests, medication and procedures they also impact the cost of health care.  The Institute of Medicine estimates that of the 2.5 trillion dollars spent on health care in 2009, 210 billion was on unnecessary services.  These would include services done too frequently, or inappropriately e.g. when practicing defensive medicine or ordering a more expensive test when a cheaper test would be more appropriate.  

The environment of fee-for-service medicine drives volume-based rather than value-based medicine.  Physicians often don't have any incentive not to order a test.  If they refuse to order a test that a patient may think is needed, they risk affecting their patient satisfaction scores or in case of an adverse outcome, a lawsuit.  

In this setting, how can physicians better practice value-based care that provides high quality at lower cost and less harm?  

I recently had an opportunity to co-present on this issue to an audience of UGME, GME and CME educators.  To highlight the problem of teaching the practice of value added care I created a few animated videos and asked the audience whether their trainees would be comfortable making the right decision.

Case 1.

Back Pain by Neil Mehta on GoAnimate

Audience Poll immediately following the video (They were told there were no Red Flags on history or exam):

Case 2 annual exam by mehtan1 on GoAnimate

Audience Poll immediately after viewing the video (Assume patient had regular screening with no abnormal Paps and no history of high risk behavior)

How can we help our health care providers make the right decision with their patients? The ABIM Choosing Wisely initiative is one big step forward in this direction. The SGIM EBM Task Force is creating "Bottom Line Summaries" which are one page handouts that physicians can use for shared decision making with their patients. Do you think these will help? Please review the Bottom Line Summaries (under the Web-Only section) and feel free to share these with your colleagues. 

Neil Mehta, MBBS, MS