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Jeffrey Kullgren, MD, MS, MPH, a general internist and researcher from VA’s Center for Clinical Management Research and the University of Michigan Medical School has a method for implementing Choosing Wisely® recommendations. He relies on a behavioral economics technique referred to as “precommitment” which, in this instance, calls upon physicians to make choices rooted in medical professionalism.
How is it that when the health care system is going through needed and positive changes, people like Pamela Hartzband and Jerome Groopman write an opinion piece in The New York Times in which they profess a longing for the “good old days” before measurement? For a moment, let’s go back to those old days. They weren’t as good as they think they were.
This post was written by Amy Berman, BS, RN and first appeared on the John A. Hartford Foundation blog.
I live with stage IV cancer—cancer that has spread to the far reaches of my body, an incurable disease, a terminal diagnosis. But if you saw me—if our carts randomly bumped into each other in the supermarket—you would never think I live with serious illness.
And let me add that I feel as well as I look, just great.
I am four years into one of the most devastating diagnoses and I haven’t visited a single hospital. This means that my care is much lower cost than others in my situation. How is this possible?
One answer is that my health care team and I choose wisely.
Most issues in health care are replete with nuance rather than absolutes. I was reminded of this recently at the National Physician Alliance’s (NPA) 2014 Annual Conference & Transforming Healthcare Summit.
NPA is considered a “progressive” physician leadership organization. It champions transparency in the disclosure of conflicts of interest, health care reform and avoiding waste and overtreatment. In fact, NPA, with a small grant from the ABIM Foundation, originally conceived the Good Stewardship Project which identified five tests and procedures in internal medicine, pediatrics and family medicine that were wasteful, and served as the precursor to the Choosing Wisely® campaign.
Help Light the Path from Volume to Value: The Second Annual Teaching Value and Choosing Wisely Challenge
Clinicians are increasingly accountable for delivering better care at lower cost. Despite the rapid evolution of the health care system, many of us still feel left in the dark. Fortunately, there are beacons of light scattered across the United States.
Since the Choosing Wisely campaign launched in 2012, there have been definitive moments when it felt like what we’re doing is really moving the needle and that change is on the horizon. Never have I felt that more strongly than at the Henry Ford Physician Network (HFPN)’s annual summit, “Collaboration for the Future.”
As a physician, is it possible to remain professional and market yourself? While it is understandable that physicians and physician researchers need to promote themselves to get jobs, patients, research grants etc., it should never come at the cost of patient care or trust.
I received a call from a colleague affiliated with one of the specialty society partners of the Choosing Wisely® campaign who wanted to vent about Jeanne Whalen’s Wall Street Journal piece entitled, “Hospitals Cut Costs by Getting Doctors to Stick to Guidelines: ‘Choosing Wisely’ Campaign Has Physicians Weigh in on Standardizing Care.”
“Outrageous!” was the reaction of some physician leaders to a recent article in The New York Times by Elisabeth Rosenthal entitled After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know. In the piece, Rosenthal tells the story of a patient negotiating charges for his neck surgery to correct herniated disks even as he was being wheeled into surgery. This patient was asking for price transparency, something many patients are now asking for as they experience the expanding world of Consumer Directed/High Deductible health plans. The patient was subsequently “blindsided” by a bill for $117,000 from an assistant surgeon whom the patient didn’t know. What’s more, the physician was out-of-network, which supposedly allows the doctor to charge any amount. The patient could not negotiate this bill – he was lying unconscious on the surgical table.
I recently met with former CEOs of prepaid group practices (PGPs) that were part of the early years (1984-2000) of the HMO Group—now the Alliance of Community Health Plans—a coalition of not-for-profit, pre-paid group practices. (I was the first president and CEO.) One of the most notable accomplishments of this alliance back then was the creation of HEDIS. Since my trip, I have been reflecting on the similarities and differences of the state of the health care industry 30 years ago and what it is now.