We recently returned from the National Summit on Healthcare Price, Cost, and Quality Transparency, where leading thinkers convened to discuss next steps in a growing movement to hold caregivers accountable for delivering better care at lower costs. Traditionally quality, cost, and patient experiences remained locked inside black boxes of individual patient–physician encounters. However, at the cusp of 2014, the window of opportunity to shine a light on physician performance appears to be permanently jammed open by public demand, payer pressure, and a technology marketplace that is eager and capable of making it happen. Continue reading Connecting Physicians to Health Care Cost Transparency
Residency is like the adolescence of medical training. Residents are testing boundaries, learning their limits, and developing their diagnostic and therapeutic skills. Much like a young bear learning to fish, residents learn by doing under the close supervision of a faculty physician. Mama bear won’t let her cub starve and faculty won’t let the residents cause harm. When given the chance, however, residents will push those boundaries to the limits in an attempt to best each other. They are, inherently, competitive creatures. Much like the proud bear with a big salmon, the resident with the rarest diagnosis or the most abnormal lab value becomes the alpha doctor. At Yale School of Medicine, we leverage this competitive atmosphere to engage residents in learning and education.
Earlier this year, we launched the Teaching Value and Choosing Wisely Competition in conjunction with Costs of Care and the ABIM Foundation. Why a competition? Not surprisingly, traditional “literature review” yielded little by way of promising strategies for educators who wished to learn how to teach about value. However, we all had learned of isolated stories of success, occasionally through attending professional meetings, sometimes via networking with colleagues, or more often through word of mouth.
To help bring these stories of success to the fore, we relied on a crowdsourcing model by launching a competition to engage a larger community of individuals to tell us their stories. Of course, there were moments we wondered if we would get any submissions. Continue reading The Wisdom of the Crowd: Finding the Most Promising Innovations to Teach Value
Originally posted on July 29, 2013
2011 Putting the Charter into Practice grantee, Costs of Care, recently released the Teaching Value Project (www.teachingvalue.org), a series of educational video modules that spotlight ten reasons why clinicians commonly overuse medical tests and treatments. The videos are directed at residents and medical students; though I imagine some faculty could benefit from seeing them. (If the learning experience from these videos is to be maximized, faculty need to see them.)
By Neel T. Shah, MD
Back in April, Costs of Care partnered with the ABIM Foundation to launch the Teaching Value & Choosing Wisely Competition, an effort to crowd-source ideas on ways to teach medical students and residents about high-value care. In prior posts on Wing of Zock, we pointed out that although learning how to deliver value is more important than ever, previous attempts to teach value have been unsuccessful. We hypothesized that medical educators have been thwarted for more than four decades by fickle political and public will demanding a higher-performing system.
In 2010, everything changed. The Patient Protection and Affordability Act (“Obamacare”) was signed into law; smartphones (and the on-demand consumer transparency they enable) became ubiquitous; and the medical profession began to step into action. By 2012, the IOM wrote Best Care at Lower Costs and the ABIM Foundation created the Choosing Wisely Campaign. The time to begin closing the gap in medical education had arrived. Continue reading Competition Entries Show Future of High-Value Care is Bright
The pressure on physicians to provide better care at lower costs is coming from all directions — top down from policymakers who want more accountability in how healthcare resources are being used; and bottom up from patients who want more transparency in how their money is being spent. Obstetricians and gynecologists have not been spared any scrutiny. As primary care providers for many women, we are in thick of the debate on appropriate use of pap and mammography screening. As surgeons, we also find ourselves increasingly answering for the expense and morbidity of unacceptably high C-section rates.
Medical education’s efforts to incorporate the teaching of value-based care into formalized curricula have been remarkably few and fraught with challenges. More than 60 percent of med school grads feel they get inadequate instruction in medical economics, a figure that hasn’t budged in more than five years. At the same time, residents are subjected to the insidious influence of a “hidden curriculum” that seems to shun conservation in favor of consumption. The result is predictable: We are churning out providers who feel neither prepared nor compelled to allocate clinical resources more sustainably.
At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring, the problem is not new.
In 1975, the department of medicine at Charlotte Memorial Hospital initiated a system to monitor medical costs generated by house officers. In the Journal of Medical Education, leaders of the Charlotte initiative reported that simply being aware of how clinical decisions impact the costs of care could decrease inpatient length of stay by 21 percent.