All doctors should understand how the decisionsthey make impact what patients pay.© Copyright. All Rights Reserved. Cost o...
© Copyright. All Rights Reserved. Cost of Care. 2DisclosuresPutting the Physician Charter into Practice Grant“The physicia...
© Copyright. All Rights Reserved. Cost of Care. 3Changing LandscapePatientstransparencyPolicymakersaccountability
© Copyright. All Rights Reserved. Cost of Care. 4
© Copyright. All Rights Reserved. Cost of Care. 5Reimbursement Reformfixed budgetfee-for-servicedo more, make moreglobal p...
© Copyright. All Rights Reserved. Cost of Care. 6Annual Contribution to Premiums (Family Coverage)Kaiser Family Foundation...
© Copyright. All Rights Reserved. Cost of Care. 7Patient Affordability: MAThe Access Project, 2009Insured non-elderly adul...
© Copyright. All Rights Reserved. Cost of Care. 8Insurance Benefit Transparency“HHS Unveils Requirements forConsumer Insur...
© Copyright. All Rights Reserved. Cost of Care. 9Consumer-directed Price Transparency>30 states are considering or pursuin...
© Copyright. All Rights Reserved. Cost of Care. 10
© Copyright. All Rights Reserved. Cost of Care. 11
© Copyright. All Rights Reserved. Cost of Care. 125-Strongly Agree
© Copyright. All Rights Reserved. Cost of Care. 13Significantly MoreModerately MorePercent more influenced 57% 67%
© Copyright. All Rights Reserved. Cost of Care. 14Graham JD, Potyk D, Raimi E. Hospitalists awareness of patient charges a...
© Copyright. All Rights Reserved. Cost of Care. 15The ProblemOrganization for Economic Cooperation and Developmenthttp://s...
© Copyright. All Rights Reserved. Cost of Care. 16The Problem“We seem to have as much as $700billion a year in health care...
© Copyright. All Rights Reserved. Cost of Care. 17Are doctors being reckless?
© Copyright. All Rights Reserved. Cost of Care. 18multiple stakeholders with different information
© Copyright. All Rights Reserved. Cost of Care. 19doctors are trained to take care of the patient in front of usThe “syste...
© Copyright. All Rights Reserved. Cost of Care. 20Roadmap✓✓✓
© Copyright. All Rights Reserved. Cost of Care. 21April 2010, NEJMNov 2011, Acad MedSep 2011, Ann Intern Med
© Copyright. All Rights Reserved. Cost of Care. 22The Congress should authorize the Secretary tochange Medicare’s funding ...
© Copyright. All Rights Reserved. Cost of Care. 23The indirect medical education (IME) payments abovethe empirically justi...
© Copyright. All Rights Reserved. Cost of Care. 24
© Copyright. All Rights Reserved. Cost of Care. 25Hidden Curriculum• imbalanced focus onidentifying rare cases• sins of om...
© Copyright. All Rights Reserved. Cost of Care. 26Ten Reasons Trainees Knowingly Over-Order Tests1. Pre-emptive ordering•S...
© Copyright. All Rights Reserved. Cost of Care. 27“Taxonomy” of Cost-Consideration
© Copyright. All Rights Reserved. Cost of Care. 28Ethical Motivation for Considering Costs??Good for patientGood for socie...
© Copyright. All Rights Reserved. Cost of Care. 29“Taxonomy” of Cost-Consideration
© Copyright. All Rights Reserved. Cost of Care. 30“Taxonomy” of Cost-Consideration
© Copyright. All Rights Reserved. Cost of Care. 31“Taxonomy” of Cost-Consideration
© Copyright. All Rights Reserved. Cost of Care. 32Target the marginserial ultrasoundsmode of hysterectomy
© Copyright. All Rights Reserved. Cost of Care. 33Web-based Education: Teaching Value Project
© Copyright. All Rights Reserved. Cost of Care. 34www.TeachingValue.org
© Copyright. All Rights Reserved. Cost of Care. 35
© Copyright. All Rights Reserved. Cost of Care. 36Teaching Value & Choosing Wisely ®
© Copyright. All Rights Reserved. Cost of Care. 37Costs of Care Essay Contest
© Copyright. All Rights Reserved. Cost of Care. 38“Less Is More” Teachable Moments:Trainee Perspectives –(Accepting articl...
© Copyright. All Rights Reserved. Cost of Care. 39Medical Decision-MakingSafetyEfficacy Cost
© Copyright. All Rights Reserved. Cost of Care. 40How much can we save?$700 billion low value health care spending X20% va...
© Copyright. All Rights Reserved. Cost of Care. 41moving from rationing to conservationhelp bring environmentalism to heal...
© Copyright. All Rights Reserved. Cost of Care. 42Contact Uswww.CostsOfCare.org
© Copyright. All Rights Reserved. Cost of Care. 43© Copyright 2012• This publication is the property of Cost of Care, Inc....
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The Challenge of Considering Costs while Caring for Patients

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  • Page This gives you a high level view of the taxonomy, we have put considerable thought and effort into how to elaborate this and are in the process of developing education materials.
  • Page This gives you a high level view of the taxonomy, we have put considerable thought and effort into how to elaborate this and are in the process of developing education materials.
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  • The Challenge of Considering Costs while Caring for Patients

    1. 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 & Women’s HospitalMay 18, 2013Helping caregivers deflate medical bills
    2. 2. © Copyright. All Rights Reserved. Cost of Care. 2DisclosuresPutting the Physician Charter into Practice Grant“The physician’s 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. 3. © Copyright. All Rights Reserved. Cost of Care. 3Changing LandscapePatientstransparencyPolicymakersaccountability
    4. 4. © Copyright. All Rights Reserved. Cost of Care. 4
    5. 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. 6. © Copyright. All Rights Reserved. Cost of Care. 6Annual Contribution to Premiums (Family Coverage)Kaiser Family Foundation, 2011.PremiumContributions($)CAGR 10%
    7. 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. 8. © Copyright. All Rights Reserved. Cost of Care. 8Insurance Benefit Transparency“HHS Unveils Requirements forConsumer Insurance Labels”Feb 9, 2012
    9. 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. 10. © Copyright. All Rights Reserved. Cost of Care. 10
    11. 11. © Copyright. All Rights Reserved. Cost of Care. 11
    12. 12. © Copyright. All Rights Reserved. Cost of Care. 125-Strongly Agree
    13. 13. © Copyright. All Rights Reserved. Cost of Care. 13Significantly MoreModerately MorePercent more influenced 57% 67%
    14. 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. 15. © Copyright. All Rights Reserved. Cost of Care. 15The ProblemOrganization for Economic Cooperation and Developmenthttp://stats.oecd.org
    16. 16. © Copyright. All Rights Reserved. Cost of Care. 16The Problem“We 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. 17. © Copyright. All Rights Reserved. Cost of Care. 17Are doctors being reckless?
    18. 18. © Copyright. All Rights Reserved. Cost of Care. 18multiple stakeholders with different information
    19. 19. © Copyright. All Rights Reserved. Cost of Care. 19doctors are trained to take care of the patient in front of usThe “system”The bedside… not to assume responsibility for populations
    20. 20. © Copyright. All Rights Reserved. Cost of Care. 20Roadmap✓✓✓
    21. 21. © Copyright. All Rights Reserved. Cost of Care. 21April 2010, NEJMNov 2011, Acad MedSep 2011, Ann Intern Med
    22. 22. © Copyright. All Rights Reserved. Cost of Care. 22The Congress should authorize the Secretary tochange Medicare’s funding of graduate medicaleducation (GME) to support the workforce skillsneeded in a delivery system that reduces cost growthwhile maintaining or improving quality.
    23. 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. 24. © Copyright. All Rights Reserved. Cost of Care. 24
    25. 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. 26. © Copyright. All Rights Reserved. Cost of Care. 26Ten Reasons Trainees Knowingly Over-Order Tests1. Pre-emptive ordering•Standard practice might be to order a relatively cheap screening testand then if it’s positive, order other expensive tests•Instead we sometimes just order everything at the same time so wedon’t have to wait2. Covering all bases•In medical culture, doing more is equated with being thorough.•If there are five possible conditions that may explain a patient’ssymptoms, and it’s 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 costs•An MRI in an emergency room setting can be twice the cost of anMRI for an outpatient.
    27. 27. © Copyright. All Rights Reserved. Cost of Care. 27“Taxonomy” of Cost-Consideration
    28. 28. © Copyright. All Rights Reserved. Cost of Care. 28Ethical Motivation for Considering Costs??Good for patientGood for society order testBad for patientBad for society don’t order test
    29. 29. © Copyright. All Rights Reserved. Cost of Care. 29“Taxonomy” of Cost-Consideration
    30. 30. © Copyright. All Rights Reserved. Cost of Care. 30“Taxonomy” of Cost-Consideration
    31. 31. © Copyright. All Rights Reserved. Cost of Care. 31“Taxonomy” of Cost-Consideration
    32. 32. © Copyright. All Rights Reserved. Cost of Care. 32Target the marginserial ultrasoundsmode of hysterectomy
    33. 33. © Copyright. All Rights Reserved. Cost of Care. 33Web-based Education: Teaching Value Project
    34. 34. © Copyright. All Rights Reserved. Cost of Care. 34www.TeachingValue.org
    35. 35. © Copyright. All Rights Reserved. Cost of Care. 35
    36. 36. © Copyright. All Rights Reserved. Cost of Care. 36Teaching Value & Choosing Wisely ®
    37. 37. © Copyright. All Rights Reserved. Cost of Care. 37Costs of Care Essay Contest
    38. 38. © Copyright. All Rights Reserved. Cost of Care. 38“Less 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. 39. © Copyright. All Rights Reserved. Cost of Care. 39Medical Decision-MakingSafetyEfficacy Cost
    40. 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. 41. © Copyright. All Rights Reserved. Cost of Care. 41moving from rationing to conservationhelp bring environmentalism to health care
    42. 42. © Copyright. All Rights Reserved. Cost of Care. 42Contact Uswww.CostsOfCare.org
    43. 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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