The Cost Problem: Physicians Need to Drive the Solution

There are at least three compelling reasons why physicians must lead in solving the cost problem in health care.

First, it really is a problem now. The wolf that people have been crying about for years has arrived. Municipalities, school systems, and businesses are having trouble paying health insurance premiums, and they are cutting back. Even many of those now eligible for subsidized insurance thanks to Chapter 58 still can’t afford it.

Second, physicians can do something about costs.

Third, and most important, our involvement will benefit our patients. When we get and stay involved in solving the cost problem, our patients will know that their health and welfare are being protected, not compromised.

Historically, when physicians have stood on the sideline of this issue instead of quarterbacking it, the results have been bad news for patients. Tiering is the latest example of this.

This Mass. Medical Society is looking at everything we can do to bring more reason to the current physician-rating frenzy. But we as individuals in day-to-day practice can also address the cost problem. Of course, we need to follow established evidence-based guidelines, where they exist. But research suggests that, on average, internists have evidence-based guidelines to refer to during only 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of their practice day. The rest of the time, they depend on their own clinical experience. And, more often than not, the true costs are invisible to us as we practice.

We need to actively consider costs and communicate more with one another to see how our colleagues solve problems like those we face. This fact became apparent to me during the education program at the society’s recent interim meeting. There we approached the question of cost and efficiency using two case studies that the audience weighed in on in real time, using an interactive audience-response system. That led to open, honest, and direct conversation about best practices.

It’s by sharing these best practices with one another that we can gain insight into different approaches that may improve how we practice. The perspectives of our colleagues are priceless, and they can be a part of the cost solution.

Cost is a very thorny and complex problem to solve, but we can no longer let others in the health care system take the lead. It’s our turn. It’s our responsibility.

Dr. B. Dale Magee is president of the Mass. Medical Society, the oldest continuously operating medical society in the U.S., now comprising 18,000 members;www.massmed.org

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