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Welcome to the Costs of Care community, the newest community in GHDonline's US Communities Initiative. We hope this forum will provide a place for health care providers, managers, advocates, students and others to connect and advance a discussion on the responsibility of clinicians in keeping care affordable.

To help get to know one another, please take a moment to post a brief reply introducing yourself and your work, and let us know what you'd like to see in this community - looking forward to hearing from all of you.

To get things started, I'm Jordan Harmon, one of the moderators for the Costs of Care Community, the Blog and Social Media Editor at Costs of Care, and an Administrator at NYU Langone Medical Center. I spent 4+ years in management consulting before my current position at NYU working with health systems on reducing costs through process improvements. I believe our work at Costs of Care represents a valuable step towards raising awareness on value-driven healthcare decisions- especially in medical education.

I'm excited to kick off this community and hope that you will be a part of our discussion.

Attached resource:

Link leads to: http://www.costsofcare.org/category/blog/

 
Neel Shah
Replied at 10:02 AM, 6 Nov 2013

I would like to join Jordan in welcoming everyone to this exciting new community at GHDOnline. I'm Neel Shah, the Executive Director of Costs of Care and an ob/gyn based at Harvard Medical School who will be moderating the Costs of Care community with Jordan. A more complete bio is in my profile, but the short story is that I've spent most of the last five years thinking about how the dynamics of clinical decision-making influence the value of care we provide.

Two weeks ago I attended a summit for financial managers where the CFOs of our country's major health systems concluded that managing revenue will be less important than decreasing costs in order to maintain their operating margins. Many systems have already made remarkable near-term commitments to drop hundreds of millions of dollars out of the care they provide. How can we make sure we do this responsibly, without sacrificing quality and patient experience?

Ultimately, we will need to engage clinicians and patients to find the tests and treatments that don't help patients get better. I look forward to joining you in a conversation about the best way forward

A/Prof. Terry HANNAN
Replied at 1:19 PM, 6 Nov 2013

I have recently had published an article which addresses many of the issues relating to the roles physicians (all clinicians) play in the costs of health care. What is interesting is that the inflationary costs of health care seem independent of the health system structure-public/private/both-with additional factors in the USA model. If you look at J. Wennberg's studies on Medicare/Medicaid patients the same costs factors are relevant i.e. clinical decision making is a major component of health care costs and variation.

Intern Med J, 2013 vol. 43(10) pp. 1155-64
Are doctors the structural weakness in the e-health building?
Hannan, TJ; Celia, C
Progressive evaluations by the Organization for Economic Co-operation and Development (OECD) demonstrate that health care is now or becoming unaffordable. This means nations must change the way they manage health care. The costly nature of health care in most nations, as a percentage of Gross Domestic Product (GDP) seems independent of the national funding models. Increasing evidence is demonstrating that the lack of involvement by clinicians (doctors, nurses, pharmacists, ancillary care and patients) in e-health projects is a major factor for the costly failures of many of these projects. The essential change in focus required to improve healthcare delivery using e-health technologies has to be on clinical care. To achieve this change clinicians must be involved at all stages of e-health implementations. From a clinicians perspective medicine is not a business. Our business is clinical medicine and e-health must be focussed on clinical decision making. This paper views the roles of physicians in e-health structural reforms.
© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.
Address: Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia.
Type: Journal article
PMID: 24134174 | DOI
Full Text (full-text online)

Jordan Harmon
Replied at 1:43 PM, 6 Nov 2013

Thanks and welcome Terry.

Elizabeth Glaser
Replied at 2:02 PM, 6 Nov 2013

Hi,
I am a doctoral candidate at the Heller school, Brandeis University, working in the Cost and Value group under health economist Donald Shepard. I am also a nurse for over 20 years now, working with underserved communities in the US and, at present, am working on issues in international health.
Our work in cost effectiveness and other forms of economic analysis are simply methods used to inform decisions in resource allocation, the basics of which can be taught to and understood by health practitioners. As a provider and a researcher, I have found that a better understanding of these principles help me to be an informed advocate for more efficient , effective treatments and care models. Are these methods being incorporated into medical, nursing and pharmacy school cirricula?

Elizabeth

Neel Shah
Replied at 2:08 PM, 6 Nov 2013

Welcome Terry and Elizabeth - you both make excellent points.

First, as we point out in another thread, pricing inflation and lack of transparency is a source of real financial harm to patients however this is difficult for clinicians to control at the bedside. By contrast, there is a lot of opportunity to decrease unnecessary utilization - by some estimates this accounts for one third or $800 billion in health care spending.

Second, as Elizabeth points out, there is an important role that educators in the health professions can play. We have started to create teaching tools at http://www.TeachingValue.org (available after free registration) and are sponsoring an annual challenge called the Teaching Value & Choosing Wisely Competition to inspire innovations and bright ideas among educators.

September Wallingford
Replied at 3:41 PM, 6 Nov 2013

A big hello to everyone in the Costs of Care community. My name is September Wallingford and I am the Director of Nursing Advocacy for Costs of Care. I am a Registered Nurse at Brigham and Women’s Hospital, and I am currently in my last year of graduate school, obtaining my Master of Science in Nursing with a focus on becoming an Acute Care Clinical Nurse Specialist. As my semesters come to a close, I look forward to helping Neel and Jordan moderate the Costs of Care community.

I believe incorporating the voice of the nurse into cost-containment discussions is critical. Nurses are uniquely positioned to be able to communicate and collaborate with both the medical team and the patient in order to help lower costs without negatively impacting the patient’s care. Getting the healthcare community to understand that nurses are in an influential position to deflate costs will be imperative moving forward.

I hope to encourage the voice of the nurse to be heard. I look forward to the thoughtful, interdisciplinary discussions that will emerge in the Costs of Care community.

~September

Ann Stanton
Replied at 1:33 AM, 7 Nov 2013

Hello All,

I am a PhD in Nursing student at UW-Milwaukee in Wisconsin. Although I have yet to decide on my dissertation focus area, I am intrigued by this discussion so far. Nurses can certainly have a huge impact on decreasing costs and informing patients on them through multiple avenues. In my experience, both patients and providers are kept in the dark in many senses of the term about actual costs versus reimbursement. I do not specifically recall focusing on this issue in my undergraduate education, which is interesting considering the significant role that it plays in changes to today's system of care in the U.S.

Treatment v. outcome-specific research is needed to allow for greater cost-efficiency down the road. It seems that, based on the experience of other nations, providers will adjust to decreased budgets if they can. If not, they will be replaced by providers who have figured out a way to make the system work for them.

Looking forward to learning more,

Ann

September Wallingford
Replied at 8:59 AM, 7 Nov 2013

Hi Ann,
Great to have you as a part of this community. You've touched on a significant gap that exists related to deflating costs and undergraduate nursing education. I would take it a step further and speak to this gap also existing in graduate nursing education. Similar to what Neel has found important in the world of medical academia in regards to getting medical students to better understand their roles and responsibilities in helping to deflate medical bills, I find that it is important to begin to incorporate these concepts into nursing education as well. I'm curious how you think we make this happen?
~September

Mighty Casey
Replied at 11:58 AM, 7 Nov 2013

Greetings, all - I'm a journo, writer, speaker, and ePatient who advocates for price visibility in healthcare, and medicine as a participatory sport.

I'm flying under my brand-name here, real name is Casey Quinlan. In addition to my ePatient status, I cover the hospital-medicine beat for The Hospitalist magazine (published by Wiley & Sons for SHM) as the producer of their podcast series. I wrote a book about managing medical care, "Cancer for Christmas: Making the Most of a Daunting Gift," based on my experience managing my own journey through the healthcare car wash after, yes, getting a cancer dx days before Christmas in '07. I also advocated for my 'rents thru the '90s, managing their care '00 thru their deaths, 29 days apart, at the end of '02. Patient experience? Yeah, I got that.

I'm now an evangelist for healthcare price transparency/visibility. Part of my work there is running a bi-weekly tweetchat around the Symplur-registered hashtag #hcpt (health care price transparency). I also registered #howmuchisthat, and use that on cost-related content I create and/or share.

I've linked my About.me page, since that's the shortest/tightest intro to my vast online empire =)

Attached resource:

Ann Stanton
Replied at 12:30 PM, 7 Nov 2013

Rebecca,

Thus far, my graduate education has provided me with a great opportunity to learn how about costs of care. However, I am intrinsically motivated to seek out additional information and the Time article "Bitter Pill" by Steven Brill in 3/12 really opened my eyes. In regards to undergraduate education about costs, as I mentioned, there was little information. I took the step-by-step path to where I am today via CNA, then LPN, then ADN, then BSN, working as much as I could along the way because experience is the best teacher.

I learned about cost issues "on the fly" during my own practice in nursing homes and hospitals, and not in school (until now). It is difficult to say when it is best to educate nurses about costs due to the intense coursework in LPN and ADN curricula that already seems filled up with other vital information. There is already so much to read and take-in, but a good way to start might be to discuss/present on the latest research or news articles, such as "Bitter Pill" and its follow-up, and WHO and Commonwealth Fund reports, that really shed light on the issue and hopefully captivate students to get them thinking. Educating on costs early on, before nurses are subjected to the bias involved in actually being a nurse, might bring new ideas into the field of cost control.

What is your experience and thoughts?

Hello Casey, so glad to have you involved in the discussion. Your insight and passion is inspiring.

Mighty Casey
Replied at 12:37 PM, 7 Nov 2013

Thanks, Ann - delighted to see Steve Brill's epic piece mentioned. I went out and bought a physical copy of that issue, since digital-alone just wasn't enough.

Your mention of med-ed and how hard it is to get pricing information easily opens the door to something that's a big discussion topic in the ePatient world: "let patients help." That's even the title of the latest book by one of our rock stars, ePatient Dave deBronkart. One resource that's got a lot of information is ClearHealthCosts.com, a startup run by journos who are crowdsourcing actual prices paid by actual patients in several cities, with Medicare usual-and-customaries provided for those outside the beta locations. I'd recommend taking a look, if only to see if it could be useful to you and your patients in the pursuit of finding out "how much IS that?"

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Ann Stanton
Replied at 12:07 AM, 8 Nov 2013

Yes, that article was so crazy and it explains only a small portion of the costs of care here. Great site! Thanks so much for sharing that and I cannot wait for Wisconsin to be included.

Neelam Adhikari
Replied at 12:28 PM, 6 Feb 2014

I am Neelam Adhikari, senior pediatrician, working in Nepal, one of the poorest countries in the world. Most medical care is out of pocket. Hospital admission of a child often can get a family in debt.
I have been very sensitive to this issue in my practice for many years and happy to find a platform which discusses this issue.

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