Peter J. Neumann, ScD runs the Center for the Evaluation of Value and Risk in Health (I’m an advisory board member there) so he’s well placed to initiate a forthright discussion of costs, as he’s done in today’s New England Journal of Medicine. See What We Talk about When We Talk about Health Care Costs.
Neumann focuses on a statement from the new edition of the American College of Physicians’ Ethics Manual:
Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.
The term “parsimonious” has generated a lot of pushback. That’s not unexpected, because policymakers, the health care industry and consumers continue to studiously avoid serious discussions of cost. Neumann is on the side of the ACP, and makes the following key points:
- The embrace of “more efficient, more effective, and safer care” and reducing waste is sensible and productive, but won’t really address cost growth
- Society has to face the fact that unlimited access and unlimited patient choice are unrealistic
- The Affordable Care Act’s restrictions on using comparative-effectiveness research for coverage decisions and its ban on the use of cost-effectiveness thresholds will limit the law’s impact
- It’s nice to have a “patient-centered” approach to outcomes research embodied in the Patient-Centered Outcomes Research Institute, but it hinders the cost debate by de-emphasizing “considerations of societal resources”
- Accountable Care Organizations (ACOs) are actually well placed to employ “parsimonious” care, but no one speaks in those terms
- The ACP is performing a real service by bringing up a topic that isn’t being discussed honestly
I’m fully on board with Peter, and would add a couple observations from recent news:
- The government has made a big deal about fraud recovery in Medicare, touting $4 billion in recoveries in 2011, which makes people feel good. But this is a drop in the bucket and doesn’t account for the substantial costs borne by providers to deal with compliance and intrusion and it doesn’t deal with the bigger issue of services Medicare willingly paid for but should not have
- The re-ignition of the culture war over birth control is a convenient way to avoid a serious discussion of costs. Both sides of the debate prefer it to a more honest and substantive debate on costs