Christopher Moriates

Too Much Medicine Happens Too Often The Teachable Moment and a Call for Manuscripts From Clinical Trainees

A columnist at theNew York Times asked readers, “Have you experiencedtoomuchmedicine?”Shereceivedmorethan1000 responses detailing examples ranging fromunnecessary testing and hospitalizations to useless office visits and specialist referrals.1 Patients are not the only ones worried about too muchmedicine: 42%of anational sampleofprimary carephysicians believe that patients in their own practice are receiving too muchmedical care.2 Too much medicine, or overuse, occurs in at least 3 contexts: when benefits from medical care are negligible, when thepotential for harmexceeds thepotential benefit,3 orwhen a fully informed patient would decide to forego the service. Examples of overuse include overtesting (eg, routinely ordering preoperative chest x-rays; see the Perspective in this issue4) and overtreatment (eg, coronary revascularization inpatientswith stable anginanot receivingoptimalmedical therapy). Spending on overuse is thought to substantially contribute to theunsustainablegrowth inUShealthcarecosts.5 Wastefulhealthcare is estimated tocost

Association Between Surgeon Scorecard Use and Operating Room Costs

750billionannually,6 limiting equitable access tonecessaryhealth care6 andcrowdingout spendingonotherpriorities suchaspublichealth, education, and valuable social programs.When passed on to our patients, health care costs can be financially catastrophic.7 The costs of overuse are not measured in dollars alone. Overtesting and overtreatment expose patients to potential harmsanddownstreamcomplications8—andoften lead tonet harm.Farbeyondcostconsciousness, theethicalcase foravoiding overuse, “first, do no harm,” is a powerful appeal to our professionalism.8 All thoughtful physicians want to minimize harms fromoveruse. The challenge is recognizingwhen an intervention is likely to represent overuse.

Defining competencies for education in health care value: recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative.

Importance Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. Objective To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. Design, Setting, and Participants The OR Surgical Cost Reduction (OR SCORE) project was a single–health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology–head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). Interventions From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon’s baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. Main Outcomes and Measures The primary outcome was each group’s median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index–adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. Results The median surgical supply direct costs per case decreased 6.54% in the intervention group, from

Fostering value in clinical practice among future physicians: Time to consider COST

1398 (interquartile range [IQR],

Development of a hospital‐based program focused on improving healthcare value

316-

Creating an Effective Campaign for Change: Strategies for Teaching Value

5181) (10 637 cases) in 2014 to

Professional Organizations’ Role in Supporting Physicians to Improve Value in Health Care

1307 (IQR,

Nebs no more after 24: a pilot program to improve the use of appropriate respiratory therapies.

319-

The Challenge of Understanding Health Care Costs and Charges.

5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from

Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care

712 (IQR,