Despite estimates that more than $700 billion is wasted each year on duplicative or unnecessary care that may not improve people’s health, our medical education system does not train physicians to understand how ordering tests and procedures that may not be necessary can harm patients and can directly affect costs for patients and the system. Research shows this lack of knowledge has profound consequences, as 62% of all personal bankruptcies are related to medical expenses1.
To begin educating physicians and reduce wasteful practices, the Teaching Value Project, an initiative of Costs of Care and funded by the ABIM Foundation, brought together a multidisciplinary group of medical educators and health economists to create a series of Web-based video modules that illustrate core principles of resource stewardship.
The modules center on the care of a fictional patient admitted to the emergency room and explore 10 reasons why clinicians commonly overuse medical tests and treatments, including how physicians are trained, opaque pricing structures, redundant ordering and patient requests. Each scenario is coupled with a debriefing video that includes key teaching points, including how to communicate with patients about avoiding unnecessary care and reducing overused or misused tests and procedures.
“For too long, doing more was equated with being a good doctor,” said Neel Shah, MD, Founder and Executive Director of Costs of Care. “We need to help physicians—especially those early in their careers—understand how their decisions on a day-to-day basis can reduce wasteful practices and improve the care we deliver to patients.”
The modules, now available at www.teachingvalue.org, are intended to engage trainees in graduate medical education programs, and will also be used for training both faculty and other practicing physicians in teaching hospitals, as well as students. Medical educators, including course directors, librarians and compliance officers can use the certification process built into the modules to demonstrate competency in value-based clinical care.
The Teaching Value Project was funded by an ABIM Foundation Putting the Charter into Practicegrant. This program provides financial support to professional medical organizations, health systems/hospitals, academic medical centers and medical practices as they work to advance medical professionalism. In 2011, five grants were awarded to facilitate the development of innovative, emerging strategies to advance appropriate health care decision-making and stewardship of health care resources, one of the commitments of Medical Professionalism in the New Millennium: A Physician Charter.
The Teaching Value Project complements the Teaching Value and Choosing Wisely competition announced in April. The goal of this effort is to address gaps in medical education to learn how to deliver the highest quality care at the lowest possible cost and identify the most promising innovations and bright ideas that can be successfully implemented on a larger scale. Competition winners will be invited to share their innovations at an ABIM Foundation meeting in November.
The teaching points demonstrated in the modules also help physicians advance the goals of the ABIM Foundation’s Choosing Wisely® campaign. First launched in 2012 with nine medical specialty societies and Consumer Reports, the campaign encourages physicians, patients and other health care providers to engage in conversations about overused and wasteful tests and procedures. In February 2013, an additional 17 societies announced lists and nearly 30 more have joined and will release lists in late 2013 and early 2014.
More information about Costs of Care and the Teaching Value Project can be found atwww.teachingvalue.org.
1Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United States, 2007: results of a national study. Am J Med [Internet]. 2009 Aug [cited 2013 May 23];122(8):741–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19501347