By Neel Shah, MD, Christopher Moriates, MD & Vineet Arora, MD
At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring the problem is not new.
In 1975, the department of medicine at Charlotte Memorial Hospital initiated a system to monitor medical costs generated by house officers. In the Journal of Medical Education leaders of the Charlotte initiative described how simply being aware of how clinical decisions impact the costs of care could decrease inpatient length of stay by 21%. Over the last four decades there have been dozens of similar efforts to educate medical students and residents about opportunities to improve the value of care. Some interventions were simple like the one in Charlotte, and simply revealed the cost of routine tests to their trainees. Others provided more sophisticated didactics, interrogated medical records to give trainee-specific feedback on utilization, or creatively leveraged the hospital computer order-entry systems.
Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost? How about a time you figured out a way to save money while still delivering high-value care?
As part of our second annual essay contest, Costs of Care, a nonprofit group based in Boston, is offering $4000 in prizes for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former White House Budget Director Peter Orzsag, former United States Surgeon General C. Everett Koop, Governor Jennifer Granholm, women’s health and cancer research advocate Dr. Susan Love, and Harvard University Provost Dr. Alan Garber.
The mission of Costs of Care is to expand the national discourse on the role of care providers in controlling healthcare costs. The stories we receive as part of our second annual essay contest will provide everyday examples from across the nation that illustrate the power patients and healthcare workers have to curb costs at a grassroots level. Many of the submissions we receive will be published right here on The Health Care Blog.
On Labor Day Costs of Care asked doctors and patients to send us anecdotes that illustrate the importance of cost-awareness in medicine, as part of a $1000 essay contest aiming to shine a national spotlight on a big problem: doctors and patients have to make decisions in a vacuum, without any information on how those decisions impact what patients pay for care.
Two months later we received 115 submissions from all over the country – New York to California, Texas to North Dakota, Alaska to Oklahoma. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, but also because they unveil how commonplace and pervasive these types of stories are. According to essay contest judge Dr. Atul Gawande, a surgeon and staff writer at the New Yorker, “These [stories] are powerful just for the sheer volume of unrecognized misery alone.” The following story from Brad Wright is one of the finalist submissions in our contest …
Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost and couldn’t find out?
Costs of Care, a nonprofit group based in Boston, is offering $1000 for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former U.S. Health and Human Services Secretary Michael Leavitt, Boston surgeon and New Yorker writer Atul Gawande, and former Massachusetts Governor and Democratic Presidential Candidate Michael Dukakis. According to Dr. Neel Shah, who is directing the contest, “Using everyday examples from across the country, these stories will highlight the need to make healthcare prices more transparent.”
Submissions should be no longer than 750 words and are due by November 1st. More details are available here.
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