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ACP's High Value, Cost-Conscious Care Initiative

ACP's High Value, Cost-Conscious Care Initiative, announced in April 2010, is a broad program that connects two important priorities for the College: helping our physicians to provide the best possible care to their patients, and simultaneously reducing unnecessary costs to the health care system. The initiative includes clinical, public policy, and educational components.

• ACP has joined other leading professional medical organizations in the Choosing Wisely campaign, which complements our HVCCC program. An initiative of the ABIM Foundation, the goal of the Choosing Wisely campaign is to promote thoughtful discussions among physicians, patients, and other stakeholders about how to use health care resources to improve quality of care. Each participating organization will identify its own list of five tests or procedures that are sometimes practiced but research shows may not be necessary for improved care. The lists will be unveiled in April 2012.

Clinical

ACP launched the clinical component of the initiative with the publication of “High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions” in the February 1, 2011, issue of Annals of Internal Medicine. In the paper, ACP explains the purpose of the initiative: to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, and to slow the unsustainable rate of health care costs while preserving high-value, high-quality care.

Diagnostic Imaging for Low Back Pain is the first clinical topic addressed by ACP. In a paper also published in the February 1 issue of Annals, ACP found strong evidence that routine imaging for low back pain with X-ray or advanced imaging methods such as CT scan or MRI does not improve the health of patients. The College recommends that routine or advanced imaging studies should only be performed in selected higher-risk patients who have severe or progressive neurologic deficits, are suspected of having a serious or specific underlying condition, or are candidates for invasive interventions.

In addition to the paper, a patient summary, a HEALTH TiP from the ACP Foundation, and video and audio news stories are available.

• Read "How Specialty Societies and Patient Advocacy Groups Can Advance Comparative Effectiveness Research ," co-authored by Dr. Steven Weinberger, CEO & EVP of ACP.
• Read an op-ed in the Philadelphia Inquirer from Dr. Steven Weinberger, CEO & EVP of ACP: "Pointless tests drive medical costs skyward."
• Dr. Paul Shekelle, chair of ACP's Clinical Guidelines Committee, offers insight into "High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions." Watch video.

Public Policy

ACP’s High-Value, Cost-Conscious Care initiative continues the College’s position formulated in our 2009 policy paper “Controlling Health Care Costs While Promoting the Best Possible Health Outcomes.” In January 2011, ACP released “How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?” In the paper, ACP makes the case that there is an urgent need for the country to have a discussion on how to conserve and allocate limited resources in a uniquely American way that puts the principal responsibility on patients and physicians making informed choices based on evidence.

In a September 2011 letter to the Congressional Joint Committee on Deficit Reduction, ACP made recommendations to reduce health care spending in a socially and fiscally responsible manner. The letter recommended that a national initiative be established to increase the use of high value care and reduce low value care.

Education

The next edition of ACP’s Medical Self-Assessment Program (MKSAP) will have a focus on optimal diagnostic and treatment strategies, based upon considerations of value, effectiveness, and avoidance of overuse and misuse.

Additional components of the initiative include patient education materials and possibly curricula for medical students and residents.

• Steven Weinberger, MD, FACP, Executive Vice President and CEO of the American College of Physicians, talks about his paper published in Annals of Internal Medicine, "Providing High-Value, Cost-Conscious Care: A Critical Seventh General Competency for Physicians." In the paper, Dr. Weinberger proposes a seventh ACGME/ABMS general competency, "Cost-Conscious Care and Stewardship of Resources." Watch video.

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