ACP Announces High-Value, Cost-Conscious Care Initiative: An Expert Interview With Steven Weinberger, MD, FACP

Megan Brooks

April 30, 2010

April 30, 2010 — Editor's note: According to the American College of Physicians (ACP) 2009 policy paper, Controlling Health Care Costs While Promoting the Best Possible Health Outcomes, the Congressional Budget Office estimates that 5% of the American gross domestic product (roughly $700 billion per year) is spent on medical tests and procedures that do not improve health outcomes.

With the High-Value, Cost-Conscious Care Initiative, the ACP hopes to reduce inappropriate care and encourage clinically effective care with evidence-based recommendations for specific interventions for a variety of clinical problems. The initiative was announced during Internal Medicine 2010: ACP Annual Meeting, April 22 to 24, in Toronto, Ontario.

Steven Weinberger, MD, FACP, deputy executive vice president and senior vice president of medical education and publishing for the ACP, spoke with Medscape Internal Medicine about the initiative.

Medscape: What prompted the High-Value, Cost-Conscious Care Initiative?

Dr. Weinberger: Healthcare reform and the need to address the high cost of care. A major component of this high cost is the overuse and misuse of care, particularly with diagnostic testing, but also with some treatment regimens. We felt that it was really important for the ACP to identify areas of overuse and misuse of care that are evidence-based (and also from guidelines) and to educate physicians about these areas so that we, as physicians, can make a dent in the problem of the high cost of care.

An important component of this is patient education — recognizing that patients often have expectations about care. When they go in for a particular clinical problem, they expect to come out with an order for a magnetic resonance imaging (MRI) scan or a computed tomography scan, or something like that, when in fact it may not necessarily be indicated and it really just adds to cost, adds to radiation, and does not add to their clinical care.

Another issue is the whole area of defensive medicine. We feel that if the ACP comes out with specific recommendations, physicians will have some back up — that there really is a good reason why the physician didn't order a certain diagnostic test.

Medscape: How will high-value cost-conscious care recommendations be developed?

Dr. Weinberger: We plan a multifaceted approach to try to develop these recommendations and guidelines, and to disseminate them to patients and physicians. This will be done through publications — particularly the Annals of Internal Medicine, through the courses we put out, and through other educational materials, such as the Medical Knowledge Self-Assessment Program (MKSAP). In the next edition of MKSAP, we will have a focus on the areas and the particular clinical problems for which there are real examples of overuse and misuse of care.

Medscape: How will areas of overuse and misuse be identified?

Dr. Weinberger: A number of different ways. Some of it will entail reviewing the literature and guidelines that are available, but also making use of the physician expertise within the College. In particular, we will be doing this with the education committee of the ACP, and also with members of the Clinical Efficacy Assessment Technical Advisory Committee. We've identified some really terrific practicing clinicians who will be contributing to this. The education committee will be the central vetting place for topics.

Medscape: What are the ultimate goals of the initiative?

Dr. Weinberger: The ultimate outcome that we want to see is a decrease in the utilization of, particularly, diagnostic tests that are overused and misused right now. There are several things that contribute to overuse and misuse. One is reflex by physicians, so when the patient comes in with back pain, we'll get the MRI scan when its not necessarily needed, or we'll do a daily chest x-ray for a patient on a ventilator in the intensive care unit when it's not necessarily indicated.

Medscape: Is there a timetable?

Dr. Weinberger: We have some initial articles that will be coming out in the Annals of Internal Medicine. We actually decided very recently that we have to speed up the timeline. Particularly, our governance of the ACP feels this is really a high priority. Therefore, we want to try, relatively quickly (within the next 1 or 2 months), to identify some of the really important areas — the low-hanging fruit — where pretty much everyone would agree there is overuse and misuse of care, and get those things out there to our physicians. Expanding on this would happen over the course of the next year or 2.

Medscape: And the funding for the initiative?

Dr. Weinberger: We are in the process of looking for some external support but, at least initially, we will be using resources and staff physicians at the ACP, as well as the volunteer resources of our committees and our governance.

Dr. Weinberger has disclosed no relevant financial relationships.

Internal Medicine 2010: American College of Physicians (ACP) Annual Meeting; Presented April 23, 2010.

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