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NPA Names 'Top 5' Cost Drivers in Primary Care

John Commins, for HealthLeaders Media, May 24, 2011

An earlier version of this article incorrectly identified the journal in which the NPA study will be published.

A study in an upcoming issue of the Archives of Internal Medicine has created a field-tested "Top 5" list of potentially unnecessary cost drivers for primary care that -- if limited -- could improve cost and efficiency.

Stephen R. Smith, MD, a family medicine physician in New London, CT, and a lead author of the study published Monday in the online edition of AIM – told HealthLeaders Media that primary care physicians are often motivated to perform unnecessary and costly practices either out of habit, or because of defensive medicine. Patients also pose a challenge. 

"The other thing is we heard from a lot of field testers that looked at this list and gave us an opinion was 'Yes the evidence is there and we agree, But it's going to be difficult to get the patients to go along with this too,'" Smith says. "Sometimes patients come in with misunderstandings. So, it's a matter of also changing patient perceptions."

The list of recommendations – compiled by the National Physicians Alliance project -- suggest limiting antibiotics for some respiratory infections, avoiding imaging for low back pain and osteoporosis screening for certain patients, and not ordering cardiac screening tests in low-risk patients.

The NPA, working on a grant from the American Board of Internal Medicine Foundation, held a Good Stewardship Working Group teleconference to identify cost-saving, efficiency improving practices in family medicine, internal medicine, and pediatrics. The list of suggestions was culled after they were weighed against evidence in scientific literature.

Members of the specialty working groups recruited other physicians to test the suggestions in the field; each of the 83 testers rated the activities by way of an online survey. A mass e-mail to all NPA members recruited 172 other physicians for a second round of field testing, which involved completing the same survey that the initial testers completed. "Each activity was to be well supported by evidence, have beneficial effects on patient health by improving treatment and/or reducing risks, and, where possible, reduce costs of care," the article said.

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1 comments on "NPA Names 'Top 5' Cost Drivers in Primary Care"


Arun (5/24/2011 at 11:41 AM)
NPA 's list is very encouraging for the patients, and third party payers because primarily it makes sense and leads to a major paradigm shift; something the current ACO concept seems to be promoting. What concerns me is the lack of information on the studies showing that reduced diagnostic testing and use of antibiotics actually has no impact on the quality of care patients are conditioned to expect from our physicians. There are individualized studies but combining their outcomes and forming a new practice protocol and getting recommended by the authoritative bodies is missing. Another aspect lacking in this approach is there is no safe harbor for a practitioner if he or she chooses to change the practice protocol and adopt these five Cost Driver reduction suggestions. There has to be strong correlation properly established between the practice without unnecessary testing etc., and prognosis indicating absence of those tests or drugs have actually benefited the patients. After that it has to be legally adopted something like making it a part of " Meeting Medical Necessity" gate-keeping. This will absolve a practitioner from any unfavorable outcomes unrelated to their actions of not conducting certain testing or using drugs and ward off the ever vigilant medical liability chasers; the very reason often given by most physicians for adopting the defensive medicine. The Top 5 Cost drivers are known to the Cost Accountants and Analyst of all payers and medical wisdom is without doubt present but without the fundamental changes in the Medical Mal Practice doctrine, laws and regulations it will be a hard sale to all practitioners.