Costs of Health Care: Teaching Medical Residents How to Provide Cost-Conscious Care

Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical CenterMedicalResearch.com Interview with:
Mitesh Patel, MD, MBA
RWJF Clinical Scholar, University of Pennsylvania
Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical Center

MedicalResearch.com: What are the main findings of the study?

Dr. Patel: We evaluated survey responses from nearly 300 internal medicine residency programs directors to assess whether residency programs were teaching residents the fundamental concepts of practicing high-value, cost-conscious care.  We found that 85% of program directors feel that graduate medical education has a responsibility to help curtail the rising costs of health care.  Despite this, about 6 out of every 7 internal medicine residency programs have not yet adopted a formal curriculum teaching new physicians these important concepts.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Patel: About half of the programs did not agree that their faculty members consistently role-modeled cost-conscious care.  Since these faculty are the ones responsible for teaching concepts and assessing competency, this is a concerning finding that needs more attention.  However, we did find some hope in that 50% of programs stated they are actively working on ways to improve and adopt a more formal curriculum.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Patel: There is a lot of opportunity to continue to improve upon current cost-conscious care curricula.  An ideal curriculum would need to incorporate multiple forms of teaching and assessment methods that are well integrated into residency training and clinical practice. This could include core lectures and didactic sessions, making resources available on the costs of tests and treatments, and to be most impactful be integrated within provider discussions related to clinical care.   Clinicians and patients should look for ways to integrate questions and discussions around the value of care into the clinical setting.

MedicalResearch.com: What resources are available to help improve the practice of high-value, cost conscious care?

Dr. Patel: In my prior research, we created the VALUE Framework, which is a mnemonic for a simple and concise tool that clinicians can use at the point of care to evaluate whether a test or treatment will provide value to their patient.  This publication also has over 20 recommendations for residency programs to integrate training on these concepts into their current structure.

For medical schools, we’ve proposed a national curriculum in health policy that can help teach the fundamental concepts that a future physicians will need to effectively translate new health policy into clinical care.

Health systems and hospitals can look for ways to leverage concepts from behavioral economics to impact change in provider behavior and improve the practice of high-value, cost-conscious care.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Patel: There is a significant need for further research and evaluation on this important topic.  We encourage programs or health care settings that have implemented curricula or methods to help improve the practice of high-value, cost-conscious care to help evaluate and study their outcomes so impactful changes can be disseminated and adopted more broadly.

Citation:

Teaching Residents to Provide Cost-Conscious Care: A National Survey of Residency Program Directors

Patel MS, Reed DA, Loertscher L, McDonald FS, Arora VM. Teaching Residents to Provide Cost-Conscious Care: A National Survey of Residency Program Directors. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.13222.

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