ACP: Reducing expenses at the ground level of health care

A guest column by the American College of Physicians, exclusive to

I will never forget asking my teenage son what appeared to be a simple question. His answer, after a long pause, was “It’s complicated.” If you ask many of us about health care in the U.S., there is often an answer that points quickly to a particular villain or a simple fix that would change everything. Unfortunately things are seldom that straightforward.

We feel better using brief sound bites which seem to have become the universal political language of the 21st century. Where does that get us? We need to start working together toward real change.

There are certainly many changes we need to make on a societal level regarding diet and exercise that we can address at a different time. I would like in this column to talk about some things we can do on a day to day basis with our patients to get good outcomes at a more reasonable price.

My Scottish ancestors were known for frugality. Some of my friends have used similar terms to describe me. I must confess that I use due diligence, sometimes to excess, when making purchases for my family. I will take Consumer Reports and cross reference it with other sources online to get an idea about how others have fared with a particular product. With that information I feel empowered to make more informed choices.

During my residency training in the early 1980s the late Hall S. Tacket, MD, MACP irritated the hospital where I trained by asking for a price list of tests and procedures we might order as internal medicine residents. This information was not easy to come by and was not particularly helpful to the hospital, which was paid on a cost plus basis in those days. Internists were famous for considering every possibility and Dr. Tacket tried, prophetically, to instill cost consciousness in health care.

For over ten years I have served in various leadership capacities for the American College of Physicians (ACP).  During that time we have taken significant steps toward encouraging more cost-effective care. We have gathered that information and put it together in ACP’s High Value, Cost-Conscious Care Initiative.

This approach is important in financing health care for those who currently have good access. These costs as we know are high and rising in an unsustainable way for all paying the bills, whether individuals, employers, or taxpayers. These rising costs are making it harder for the uninsured to find coverage, whether individually or through a comprehensive plan to attain universal coverage.

If we are able to lower or at least flatten the rise in health care costs, then we should have fewer people who live sicker and die younger due to lack of health insurance. ACP believes, as do I, that one way to do this is by decreasing the overuse and misuse of diagnostic testing and treatments that do not help patients or might even be harmful.

ACP will continue to work on educational content to help patients and doctors more effectively explore our options and use resources wisely. We have found a collaborator to help in these efforts. Consumer Reports has a long track record in effectively promoting value-based purchasing. With the educational strength of ACP and the expertise and outreach of Consumer Reports, we hope to effectively collaborate in a way that adds credibility and impact to cost consciousness efforts and begins to change expectations of patients.

It is important to note that these efforts are different from the excesses in denials of needed care by managed care organizations in the past. Rather than withholding effective care, we seek to educate clinicians and patients about how to identify and eliminate wasteful, ineffective practices. While the inevitable political rhetoric is likely to appear, we need to find ways to better understand and communicate that the latest technology does not always help us and may even hurt us.

This effort is about reducing the significant percentage of health care expenses in the U.S. that do not add value. If we can eliminate only a portion of these expenses then we have begun to move in the right direction. By reducing expenses to those that are helpful at the “ground level” of health care, then we can begin to find the most effective ways to pay for this care.

Fred Ralston practices internal medicine in Fayetteville, Tennessee, and is a Past President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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