Caring for Patients with Wise Resource Choices

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Reducing health care costs dominates current health policy discussions. A key question in these discussions is who is responsible for bending the cost curve? Steven Brill’s article in Time magazine examined the roles of manufacturers, hospital administrators, and health care providers. In a recent article in The Boston Globe, Reducing health costs: a bitter pill, chewable for doctors, Dr. Ishani Ganguli focuses on providers and the challenges they face in becoming better stewards of health care resources.

Ganguli argues that doctors can play a significant role in cutting costs by being mindful of the overuse of resources. He highlights a recent publication in the Journal of the American Medical Association on the work of Chris Moriates, University of California, San Francisco. Moriates and colleagues have developed an introductory lecture for interns on health care costs. The interns in attendance review a case study of a recently discharged patient from UCSF Hospital, including an itemized hospital bill. They compare the costs of treatment using evidence-based guidelines versus commonly-used procedures. This exercise allows students to see the cost implications of their treatment decisions and reflect on the consequences of diverging from standardized guidelines. 

Another effort to encourage providers to exercise control of health care costs is the American Board of Internal Medicine’s “Choosing Wisely” Campaign, which aims to identify practices, tests, and procedures in various specialties whose value and use should be questioned and discussed. Ganguli reiterates that these efforts are not about withholding necessary care, tests, or treatments to individuals for the sake of the bottom line. Rather, it is about encouraging providers to use resources judiciously. 

In a current HCFO-funded study, Carrie Colla, Ph.D., Dartmouth University, and Meredith Rosenthal, Ph.D., Harvard University, are assessing the prevalence, regional variation, and correlates of overuse of low-value services as designated by the Choosing Wisely initiative. The goal of the project is to lay the ground work for a policy agenda to reduce future utilization of low-value services and to generate hypotheses about effective payment and insurance reforms to moderate the provision of these services.

To ensure a sustainable health care system, providers will need to consider wise resource choices along with wise treatment choices for their patients.