Cost-Effective Care in the ED - Dr. Sawyer

Background on Costs of Care in the US

· Health Care expenditure consumes 17.7% of US GDP, almost twice the average of other industrialized nations at 9.3%.
· Heath outcomes indicators are no better in the US than in other industrialized nations.
· Unnecessary medical tests and procedures are estimated to cost $700 billion/year in the US, 5% of GDP.
· Approximately 2/3 of US bankruptcies are due to medical bills.


Defining Value in Health Care

·  Value = (Outcomes/Cost)
·  Outcomes are dependent on results, not the volume of medical tests and procedures we order/perform.
·  Costs are dependent on the volume of medical tests and procedures we order/perform.
· To increase value, we must improve outcomes, while being mindful of the volume of medical tests and procedures we order/perform.


Cost-Effective Care Strategies in the ED

· Utilize validated clinical decision rules (CDR) such as the Canadian Head CT Rule, and basic published guidelines such as the ACEP “Choosing Wisely” List of Top 5 Things Physicians & Patients Should Question.
· CDR and publish guidelines are only effective in reducing costs if available to Physicians at time of order entry.  Thus, electronic medical records should integrate decision support tools as part of the flow of order entry.
· Cost transparency & Physician Cost Sensitization have been shown to help reduce costs of care when the Physician knows the cost of the interventions they are ordering.
· Utilize Lean Methodology to improve workflow, eliminate waste, and improve outcomes.


Considerations

·  Diagnostic laboratory testing/ imaging, as well as admissions are important uses of resources; remember this during your daily practice.
· Physician practices are established in Residency and are difficult to modify after completion.
· Learning to be a good steward of health care dollars is an important part of medical education and will continue to have an ever increasing impact on our practice; take costs of care into consideration with every patient encounter.

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