New ABIM Foundation Grants Address Issues of Resource Use in Health Care System

As part of its effort to help physicians and patients “Choose Wisely” about health care resources, the ABIM Foundation, in partnership with the Council of Medical Specialty Societies, has awarded five grants to a diverse group of health care organizations for projects to advance professionalism among practicing physicians as part of its Putting the Charter into Practice  initiative.

Grant recipients include the American College of Physicians, Johns Hopkins Bayview Medical Center, National Physicians Alliance, Costs of Care (a non-profit organization located Boston) and the University of Minnesota’s Division of Pediatric Emergency Medicine.

These grants will facilitate the development of innovative, emerging strategies to advance appropriate health care decision-making and the stewardship of health care resources, one of the commitments of Medical Professionalism in the New Millennium: A Physician Charter. Authored by the ABIM Foundation, in partnership with the American College of Physicians Foundation and the European Federation of Internal Medicine, the Physician Charter promotes the primacy of patient welfare, patient autonomy and social justice. It also articulates the professional responsibilities of physicians, including a commitment to improving quality and access to care, advocating for a just and cost-effective distribution of finite resources and maintaining trust by managing conflicts of interest.

The Physician Charter states: “While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources.”

The projects initiated by Putting the Charter into Practice grantees come at a critical time for the U.S. health care system. According to the Centers for Medicare & Medicaid Services, national health care expenditures are projected to increase from 17.3 percent of the nation’s GDP in 2011 to 19.3 percent in 2019.

“Improving the use of finite resources is crucial to addressing the unsustainable growth of our health care system,” said Christine K. Cassel, MD, President and CEO of the American Board of Internal Medicine and ABIM Foundation. “The tools developed by the Putting the Charter into Practicegrantees will equip physicians with the competencies and system support needed to engage patients and families in choosing wisely about their health care decisions.”

This year’s Putting the Charter into Practice grantees are:

• American College of Physicians (ACP) — The American College of Physicians Center for Ethics and Professionalism will develop case studies focusing on the professional considerations relevant to physician decisions about resource allocation and stewardship. The case studies will be available for CME credit and presented at educational sessions at future ACP annual meetings.
• Costs of Care — Through this project Costs of Care, a non-profit organization in Boston will create an interactive, case-based video module to facilitate reflective learning among students, house staff and faculty physicians about the costs of medication, laboratory testing, imaging and procedures, and the financial consequences of unnecessary inpatient and outpatient services. The group will also create web-based CME modules for The Doctors Channel based on the vignettes.
• Johns Hopkins Bayview Medical Center — Johns Hopkins Bayview will focus on reducing the overutilization of cardiac enzyme panels, a commonly ordered diagnostic test, by aligning physician ordering behavior with established guidelines for appropriate testing and changes in billing systems. Low performers will receive coaching; high performers will be interviewed to identify best practices. The project team will evaluate the effort based on cardiac enzyme test ordering pre- and post-intervention.
• National Physicians Alliance (NPA) — This project builds on the National Physicians Alliance’s2009 Putting the Charter into Practice grant project, which convened workgroups to develop lists of specific actions primary care physicians can take to be good stewards of resources. In this follow-up project, NPA will develop resources and train physicians to communicate with patients on tests and procedures where the potential harm exceeds benefits based on recommended lists. It will showcase exemplar communication skills in clinical practices around the country by creating educational videos and other training materials.
• Division of Pediatric Emergency Medicine, University of Minnesota — Through this project, theUniversity of Minnesota’s Division of Pediatric Emergency Medicine will develop and implement evidence-based practice guidelines and electronic clinical decision support tools for common causes of pediatric emergency room visits such as acute gastroenteritis and suspected appendicitis, two childhood conditions for which physicians commonly do not adhere to practice guidelines. This can result in overuse of laboratory testing and, in the case of suspected appendicitis, overuse of CT scans.

Putting the Charter into Practice grants awarded in 2011 continue the Foundation’s investment in organizations advancing tenets of the Physician Charter. In 2009, the Foundation awarded six grants to institutions for projects that addressed the challenges physicians face in delivering patient-centered care, managing the distribution of finite health care resources, handling unprofessional behavior and other complicated ethical situations.

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