Published Online: February 13, 2014
Current reform efforts seek to tie providers’ pay with performance, yet a recent finding suggests that less than 15% of internal medicine residency programs provide education that focuses on such training.
From the 260 residency program directors surveyed
, 15% said they had a formal cost-conscious care curriculum, while nearly half said they are working to develop one. More than a third said they neither had one, nor were they working on such a curriculum.
Many advocates, including The American College of Physicians, suggest that training in graduate medical education (GME) should emphasize high-value, cost-effective care.
"Healthcare costs continue to rise, now accounting for nearly $3 trillion annually," wrote study authors, led by Mitesh S. Patel, MD, MBA, from Philadelphia Veterans Affairs Medical Center and Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania. "Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians. To address this issue, the Medicare Payment and Advisory Commission recommended nearly $3.5 billion in funding for graduate medical education be reallocated to programs with curricula that train residents to practice high-value, cost-conscious care."
Dr Patel, et al stress that if GME is going to play a critical role in value-based healthcare, residency directors must consider training medical students about care delivery models and methods that emphasize controlling costs and enhancing quality. In addition, schools lacking such programs could adopt curriculums which have been successfully implemented at other institutions.
Louis Goodman, PhD, president of The Physicians Foundation, and Tim Norbeck, CEO of the Foundation, recently stated
that they are not as certain about such change efforts.
“No other nation in the world comes close to having the enormity of bureaucratic medical infrastructure that exists in the US today. We agree there needs to be continuing medical education and peer review, but how much? By whom? At what cost?”
Around the Web
Pay and Practice: Show Me the Cost! [MedPage Today]
Medicine's Culture Of Quality And The Critical Steps Physicians Take To Ensure The Highest Level Of Care [Forbes]