Sandra Adamson Fryhofer, MD


May 10, 2012

Sandra Adamson Fryhofer, MD
Clinical Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia; Past President, American College of Physicians

The New High Value Care Series

This issue of Staying Well highlights the new High Value Care Series, a joint venture between the American College of Physicians (ACP) and Consumer Reports. The details were unveiled by leaders of both organizations at an April 19, 2012, press conference at Internal Medicine 2012, ACP's most recent annual scientific meeting in New Orleans. As ACP President Emeritus, I was also privy to a special presentation by Steve Weinberger, MD, ACP Senior Vice President on the program,[1] whose ultimate goal is to help control healthcare costs by putting the brakes on overtesting and overtreatment.[2]

Why the New Attitude? Healthcare Costs Gone Wild

The year 2010 was all about healthcare quality and safety. These issues still stand, but the new buzzword is "cost of care," and with good reason. Healthcare costs have surged from 352 billion in 1980 to $714 billion in 1990 and $2.2 trillion in 2008, which represented 16.2% of our gross domestic product (GDP) that year.[3] The 2010 Institute of Medicine (IOM) Healthcare Imperative projects healthcare expenditures of $4.4 trillion by 2018. The IOM also estimates that $215 billion are wasted on unnecessary services, including diagnostic tests. Indeed, healthcare costs have gone wild.

But newly released data are somewhat encouraging. Although healthcare spending in 2010 represented 17.9% of the GDP, trends in 2009 and 2010 suggest a slight slowing down. The pace of spending over this period increased by less than 4% per year. Possible explanations include economic downturn (patients putting off physician visits); greater use of generic drugs; and more alignment of incentives among payment, quality, and health outcomes.

Co-branding Targets a Dual Audience

ACP's High Value, Cost-Conscious Care Initiative began 2 years ago and at that time was aimed only at internists, so the concept is not new to physicians. The advantage of the current dual sponsorship is that it will reach both physicians and patients.[4,5] Patient buy-in to these concepts is key to success. Helping educate patients on what will work and what does not takes time, a valuable commodity in a physician's office. It is hoped that ConsumerReports'focus on patients and caregivers will initiate this discussion and thus take pressure off the in office time needed for detailed explanations.[2]

Co-branding operates on a premise of mutual consent for adoptance. Nuts-and-bolts content and resource material about the program will be available at no charge on the Websites of ACP, Consumer Reports , and Annals of Internal Medicine . Consumer Reports will also reach out to its own network of other consumer organizations. Both organizations have a reputation for producing and promoting evidence-based content.

Evidence-Based Hot Topics

Consumer Reports will create topics based on clinical guidelines, a rigorous evidence-based review of the scientific literature.[6]It will present this content in a variety of ways, including stories and videos, on its Website.

Initial topics include imaging tests for low back pain[7] and choosing a drug for treatment of type 2 diabetes.[8] Educational materials on these 2 topics are now available on the Websites in both English and Spanish. Availability of evidence-based studies published in Annals of Internal Medicine provides a fact-checking nirvana for Consumer Reports. Future topics under way include use of imaging studies for evaluating headaches, syncopal episodes, and inappropriate screening for colon cancer.[2]

Founded in 1936 and with more than 8 million subscribers, Consumer Reports has a long track record of providing reliable information to the public and has its own healthcare rating center. Outreach to more than 1 million consumers is anticipated.[2] ACP Board of Regents approval is also part of the editorial process.

Relationship to the ABIM's Choosing Wisely Campaign? No Conflict

ACP's High Value, Cost-Conscious Care Initiative is complimentary to the American Board of Internal Medicine's (ABIM's) Choosing Wisely efforts, which is also part of the Consumer Reports joint venture. This campaign involves an initial 9 organizations, including ACP, that each submitted 5 practices and procedures that are often overused and not appropriate for everyone and that warrant conversations between physicians and patients. Initially, 9 societies submitted 5 recommendations. Another dozen or so are expected to add recommendations over the coming year. In addition to the ACP, the organizations in this first group were the American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; American College of Cardiology; American College of Radiology; American Gastroenterological Association; American Society of Clinical Oncology; American Society of Nephrology; and American Society of Nuclear Cardiology.[9]

Final Thoughts

More care does not mean better care. Better care does not mean it has to be more expensive. Implementing these concepts requires consumer and physician buy-in. As a member of ACP's Performance Measures Committee, expect even more performance and meaningful use measures focused on identifying overtesting and misuse of diagnostic tests. Getting appropriate care, and the right care at the right time, can reduce healthcare costs and improve the health of our nation.


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