One component of the changing U.S. medical industrial complex is a greater awareness on the part of physicians that superior health care isn’t only about science and practice management. It’s also about the efficient and fair delivery of medical care.
There is, perhaps, no better example of this awareness than a recent report that issued from an annual meeting of the American Medical Association (AMA). As the largest medical professional organization, and publisher of the Journal of the American Medical Association (JAMA) and its several specialty publications, the AMA’s pronouncements carry heft not only for members, but for anyone interested in medicine.
Last month, the AMA’s principle policy-making body, the House of Delegates, declared that the provision of effective medical care includes an “obligation” to manage health-care resources well (p. 180). As reported on MedPage Today, the statement reinforced the notion that physicians are obliged primarily to serve the interest of individuals, and that too often, caregivers make decisions that don’t consider the welfare of the patient.
That includes recognition of the cost of care.
In our monthly newsletter, we’ve discussed the idea of transparency in health care, of how medical consumers usually have little idea of what treatment costs because its purchase is clouded in bureaucracy and a sliding standard, depending on whether insurance underwrites care, and if so, to what extent. It’s refreshing to see the organization that represents so many practitioners calling for the same clarity of cost.
The report cited several cost pressures under which caregivers work, some of which are beyond their control—drug prices, for one example. “Other cost drivers, however, such as extensive use of new technologies and high intensity of services provided at each patient encounter, are influenced by physician choices,” the report read.
Doctors must refrain, the report said, from ordering medically unnecessary tests, and to provide treatments of clear patient benefit. “Wise stewardship,” the report says, is what should shape decisions about care. “More intensive and/or costlier services do not necessarily lead to better health outcomes.” Readers of this blog have heard that before.
Some doctors practice defensive medicine—that is, they overtreat because they’re afraid of getting sued for malpractice if they don’t order many tests and something goes wrong. Unfortunately, however, instead of acknowledging that bogus premise and that good care and the immediate acknowledgment of responsibility in the event of an error have been proved to thwart lawsuits, the AMA statement said only that doctors should work harder for medical liability reform in order to fully implement its vision of “wise stewardship.”
Although some doctors were concerned that cost-consciousness would make patient well-being a secondary consideration, most were in favor of what the report specifically recommended:
Base medical recommendations on patients' medical needs using scientifically grounded evidence.
Help patients and their families form realistic expectations about whether a particular intervention is likely to achieve its goals.
Choose the course of action that demand fewer resources if alternatives offer similar prospective outcome and anticipated benefit compared with anticipated harm.
Be transparent about the medical alternatives, including disclosing when a constraint on resources played a role in decision-making.
Try to resolve disagreement if a patient feels a costly intervention is worthwhile. This could include consulting other professionals.
The report also advised that “Medicine as a profession must … make it feasible for individual physicians to be prudent stewards by:”
encouraging health-care administrators and organizations to make cost data transparent;
ensuring that physicians have the training they need to be informed about health-care costs
and how their decisions affect overall health-care spending.
As MedPage Today reported, Tamaan Osbourn Roberts, a family physician, told the House of Delegates at the AMA meeting, “Stewardship is not antithetical to care of a patient. As physicians, we make decisions on resources every day. If not us, who?"