The Challenge of Considering Costs while Caring for Patients

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(c) Costs of Care 2013

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  • 1. All doctors should understand how the decisionsthey make impact what patients pay. Copyright. All Rights Reserved. Cost of Care.It must be done, but how?The Challenge of Considering Costs while Caring for PatientsNeel Shah, MD, MPPExecutive Director, Costs of CareChief Resident, Departments of Ob/GynMassachusetts General Hospital / Brigham & Womens HospitalMay 18, 2013Helping caregivers deflate medical bills

2. Copyright. All Rights Reserved. Cost of Care. 2DisclosuresPutting the Physician Charter into Practice GrantThe physicians professional responsibility for appropriateallocation of resources requires scrupulous avoidance ofsuperfluous tests and procedures- Medical Professionalism in the New Millenium:A Physician Charter, ABIM (2002) 3. Copyright. All Rights Reserved. Cost of Care. 3Changing LandscapePatientstransparencyPolicymakersaccountability 4. Copyright. All Rights Reserved. Cost of Care. 4 5. Copyright. All Rights Reserved. Cost of Care. 5Reimbursement Reformfixed budgetfee-for-servicedo more, make moreglobal paymentshared riskefficiency metricsMassachusetts to debut Medicare pay planPartners doctors to paid for total care, rather than piecemealGlobe Staff | December 10, 2011 6. Copyright. All Rights Reserved. Cost of Care. 6Annual Contribution to Premiums (Family Coverage)Kaiser Family Foundation, 2011.PremiumContributions($)CAGR 10% 7. Copyright. All Rights Reserved. Cost of Care. 7Patient Affordability: MAThe Access Project, 2009Insured non-elderly adults inMA reporting problemspaying medical billsmedical debt rates unchangedUrban Institute, MA Health Reform Survey, 201098% haveinsurance 8. Copyright. All Rights Reserved. Cost of Care. 8Insurance Benefit TransparencyHHS Unveils Requirements forConsumer Insurance LabelsFeb 9, 2012 9. Copyright. All Rights Reserved. Cost of Care. 9Consumer-directed Price Transparency>30 states are considering or pursuing legislation to increase pricetransparency (Sinaiko and Rosenthal. Increased Price Transparency in Health Care. NEJM. March 2011) 10. Copyright. All Rights Reserved. Cost of Care. 10 11. Copyright. All Rights Reserved. Cost of Care. 11 12. Copyright. All Rights Reserved. Cost of Care. 125-Strongly Agree 13. Copyright. All Rights Reserved. Cost of Care. 13Significantly MoreModerately MorePercent more influenced 57% 67% 14. Copyright. All Rights Reserved. Cost of Care. 14Graham JD, Potyk D, Raimi E. Hospitalists awareness of patient charges associated withinpatient care. J Hosp Med. 2010 May-Jun;5(5):295-7.Illustration by Peter Arkle, Bloomberg.com 7/11/11 15. Copyright. All Rights Reserved. Cost of Care. 15The ProblemOrganization for Economic Cooperation and Developmenthttp://stats.oecd.org 16. Copyright. All Rights Reserved. Cost of Care. 16The ProblemWe seem to have as much as $700billion a year in health care tests andservices that are unnecessary, thatdont improve health outcomes, andthat just add to costs ... Peter Orszag, Director of the White HouseOffice of Management & Budget.February 19th, 2009 17. Copyright. All Rights Reserved. Cost of Care. 17Are doctors being reckless? 18. Copyright. All Rights Reserved. Cost of Care. 18multiple stakeholders with different information 19. Copyright. All Rights Reserved. Cost of Care. 19doctors are trained to take care of the patient in front of usThe systemThe bedside not to assume responsibility for populations 20. Copyright. All Rights Reserved. Cost of Care. 20Roadmap 21. Copyright. All Rights Reserved. Cost of Care. 21April 2010, NEJMNov 2011, Acad MedSep 2011, Ann Intern Med 22. Copyright. All Rights Reserved. Cost of Care. 22The Congress should authorize the Secretary tochange Medicares funding of graduate medicaleducation (GME) to support the workforce skillsneeded in a delivery system that reduces cost growthwhile maintaining or improving quality. 23. Copyright. All Rights Reserved. Cost of Care. 23The indirect medical education (IME) payments abovethe empirically justified amount should be removedfrom the IME adjustment and that sum would be usedto fund the new performance-based GME program. Toallow time for the development of standards, the newperformance-based GME program should begin inthree years (October 2013). 24. Copyright. All Rights Reserved. Cost of Care. 24 25. Copyright. All Rights Reserved. Cost of Care. 25Hidden Curriculum imbalanced focus onidentifying rare cases sins of omission > sins ofcommission misperception thatconsidering cost is notaligned with patient interests 26. Copyright. All Rights Reserved. Cost of Care. 26Ten Reasons Trainees Knowingly Over-Order Tests1. Pre-emptive orderingStandard practice might be to order a relatively cheap screening testand then if its positive, order other expensive testsInstead we sometimes just order everything at the same time so wedont have to wait2. Covering all basesIn medical culture, doing more is equated with being thorough.If there are five possible conditions that may explain a patientssymptoms, and its probably going to be one or two of them, we mightorder tests for all five conditions right away.3. Not realizing how much setting affects costsAn MRI in an emergency room setting can be twice the cost of anMRI for an outpatient. 27. Copyright. All Rights Reserved. Cost of Care. 27Taxonomy of Cost-Consideration 28. Copyright. All Rights Reserved. Cost of Care. 28Ethical Motivation for Considering Costs??Good for patientGood for society order testBad for patientBad for society dont order test 29. Copyright. All Rights Reserved. Cost of Care. 29Taxonomy of Cost-Consideration 30. Copyright. All Rights Reserved. Cost of Care. 30Taxonomy of Cost-Consideration 31. Copyright. All Rights Reserved. Cost of Care. 31Taxonomy of Cost-Consideration 32. Copyright. All Rights Reserved. Cost of Care. 32Target the marginserial ultrasoundsmode of hysterectomy 33. Copyright. All Rights Reserved. Cost of Care. 33Web-based Education: Teaching Value Project 34. Copyright. All Rights Reserved. Cost of Care. 34www.TeachingValue.org 35. Copyright. All Rights Reserved. Cost of Care. 35 36. Copyright. All Rights Reserved. Cost of Care. 36Teaching Value & Choosing Wisely 37. Copyright. All Rights Reserved. Cost of Care. 37Costs of Care Essay Contest 38. Copyright. All Rights Reserved. Cost of Care. 38Less Is More Teachable Moments:Trainee Perspectives (Accepting articles now!) First author must be a trainee Story from the frontlines illustrating avoidable care Teachable Moment explaining the evidence Suggested total length: 600 words 39. Copyright. All Rights Reserved. Cost of Care. 39Medical Decision-MakingSafetyEfficacy Cost 40. Copyright. All Rights Reserved. Cost of Care. 40How much can we save?$700 billion low value health care spending X20% variable costs X70% physician-driven component = 41. Copyright. All Rights Reserved. Cost of Care. 41moving from rationing to conservationhelp bring environmentalism to health care 42. Copyright. All Rights Reserved. Cost of Care. 42Contact Uswww.CostsOfCare.org 43. Copyright. All Rights Reserved. Cost of Care. 43 Copyright 2012 This publication is the property of Cost of Care, Inc. No part of this presentation maybe reproduced, translated into another language or transmitted in any form or byany means, electronic, mechanical, photocopying, recording, or otherwise, withoutthe prior written consent of Cost of Care, Inc. Some or all of the information contained herein may be protected by patentnumbers All other trademarks are owned by their respective owners

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