A Glass Once Empty, Now Half Full

glass half full #2Twenty years ago I sat with my fee-for-service (FFS) colleagues in the auditorium of St. Joseph’s Hospital (SJH), witnessing an appeal from hospital administration to join the fight to eliminate unwarranted healthcare expense. Revenue was down, expenses up, and the CFO was worried.  Our reply was an incredulous version of “… but we (physicians) control only 20% of the total expense!”, referring to our professional fees. We preferred to blame plaintiff attorneys, pharmaceutical and device manufacturers, and the for-profit insurance companies as the cause of The Cost Problem, rather than take an appropriate portion of ownership. It was then I first heard or thought, “Ah, but 80% of the spend flows from our pens.”

blame game #2In the 20 years elapsed, we physicians traded-in our pens for keyboards and double-clicks, and SJH never did solve their price / cost equation, ultimately having to sell the hospital to Emory, which has so far been better at raising prices than lowering expense.

But what about that physician crowd in the SJH auditorium, now 20 years older? What’s their present-day point of view regarding physician responsibility for America’s Healthcare Cost Crisis?  Mayo Clinic researchers published a study this week in JAMA answering that question (Views of US Physicians About Controlling Health Care Costs, Tilburt JC, et al. JAMA 2013;310(4):380388). Thankfully, we physicians are more insightful and courageous about our role in healthcare costs than 20 years ago.

the buck stops here

Oh sure, we still like blaming the lawyers (60% of physicians), insurance companies (59%), pharma (56%), and even patients (52%), but finally we believe …

  1. We should adhere to clinical guidelines that discourage the use of marginally beneficial care (79% of docs)
  2. We need to take a more prominent role in limiting the use of unnecessary tests (89%)
  3. We have major responsibility for reducing healthcare costs (ok, only 36% of physicians agreed with that one, but that’s a glass no longer empty).

Not unexpectedly, physicians compensated through a salary (rather than FFS) and/or who practiced in a group or government setting had more enthusiasm for cost-consciousness.   Physicians who have the most to gain financially from wasteful practice will be the last to assume responsibility in controlling costs. Alas, we still have far to go before we sleep… 85% of respondents believe “the cost of a test or medication is only important if the patient has to pay for it out of pocket.” For more information, see my prior post, The Morality of Resource Stewardship.

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