Email: Responsible Care Considers Cost

Responsible Care Considers Cost
	Americans are terrified of care rationing. We worry that we’ll be refused the care we need, that waiting lists for procedures will stretch into months and years, and that government agencies will have the power to decide what care we receive.

Because of this fear, Americans tend to conflate any mention of cost-effectiveness as a consideration in medical decision-making with rationing.

The American College of Physicians just released an updated ethics manual that emphasizes parsimonious care—health care decisions that take savings into account. Some are up in arms over this term because they believe that parsimonious care will value frugality over health benefits.

The word parsimonious does have some negative connotations. But ACP doesn’t mean that providers should withhold care merely because it’s expensive. Parsimonious care means that practitioners should critically consider costs as part of responsible decision-making. “Parsimony shouldn’t override a treatment decision that could benefit an individual patient. The real goal is to avoid wasteful, ineffective care that is not only costly, but likely to be harmful in the long run,” says journalist Naomi Freundlich.

Parsimonious care can be beneficial for patients and providers alike, saving both money and time and avoiding complications from procedures that might not be necessary.

In keeping with this principle of responsible care, HealthPartners announced recently that it is implementing a new policy for those who are considering back surgery. Now, before seeing a surgeon, patients with back problems must consult a “designated spine specialist” who will evaluate their condition and provide them with more information about their treatment options.

Mounting evidence shows that aggressive surgery is not necessarily the right option for every patient. Alternative therapies have been shown to be superior in some cases, especially for patients with lower back pain.

This policy does not mean that a system of gatekeepers will bar patients from beneficial surgery—HealthPartners still allows patients to see a surgeon if they so choose. But a consultation with a spine specialist encourages informed decision-making. This means satisfied patients as well as savings. Grand Rapids, MI-based Priority Health ran a similar program that reduced surgeries 26%, with 87% of patients saying they had better knowledge of their treatment options and almost 75% reporting satisfaction with care.

Practicing parsimonious care doesn’t mean we’ll have to forgo the treatment we need. It means that practitioners will be more responsible with care decisions, patients will be more informed about treatment options, and people will receive effective and efficient care.

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