National Physicians Alliance

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What is the Value of Teaching Stewardship?

Posted by October 6, 2014 at 1:44 PM


NPA Values Challenge: The CBO’s $95 Billion reduced projection in Medicare spending means that “the federal government’s long-term budget deficit is considerably less severe than commonly thought just a few years ago.”

In their NYT piece, “Medicare: not such a budget-buster any more,” Margot Sanger-Katz and Kevin Quealy take on an issue addressed in NPA’s new policy brief, Values and Value in Health Care. NPA leaders have endorsed the principle that physicians and other providers need to develop a culture of stewardship of finite resources and these principles need to be built into curricula and board certification.

Do Sanger-Katz and Quealy make a convincing case for promoting a culture of clinical stewardship or not? How big a role has a new culture of stewardship played in recent years? Can any mechanism to reduce spending be sustained and successful without a growth in the culture of stewardship?

Read their piece below and tell us what you think. Your responses to NPA blog posts help us refine our communications about important issues and influence the choice of initiatives we undertake.

Every year for the last six years, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a report from the budget office on August 27. The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion. That sum is greater than the government is expected to spend that year on unemployment insurance, welfare and Amtrak — combined. It’s equal to about one-fifth of the expected Pentagon budget in 2019. Widely discussed policy changes, like raising the estate tax, would generate just a tiny fraction of the budget savings relative to the recent changes in Medicare’s spending estimates.

In more concrete terms, the reduced estimates mean that the federal government’s long-term budget deficit is considerably less severe than commonly thought just a few years ago.

Every year, the C.B.O. puts out its best guess for what the country will spend on Medicare over the next 10 years. In 2019, the C.B.O. now estimates the United States will spend about $11,300 in 2014 dollars to care for each person in Medicare. That’s down from around $12,700 from the 2010 estimate. Now multiply that number times the 62.5 million people in Medicare. Much of the recent reductions come from changes in behavior among doctors, nurses, hospitals and patients….

For the full article, click here.

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2 Responses to “What is the Value of Teaching Stewardship?”

  1. Howard Selinger says:

    To my way of thinking practicing stewardship of our healthcare resources is no different than respecting the importance of “the common good”. Many times in a given week I repeat to my patients, “there is no reason to do a test unless we plan to do something with the results OF that test”. In my world of ambulatory family medicine I drive home to my patients the point quite often that more medicine is not necessarily better medicine and often is worse medicine.

    The clinician-patient relationship, when well-established, often opens the door for a meaningful discussion about what tests, treatments and investigations a patient may need but just to soften may not need. In our highly technical age there is no better reassurance to my patients that I am only a click or a text away if I am needed to provide information, reassurance or intervention.

    Access, availability and a solid therapeutic relationship are without a doubt the most valuable services we provide in primary care. Couple this with a critical appraisal of resource utilization in taking care of patients and we have a winning combination!

  2. Mark Ryan says:

    Agree with what Dr. Selinger wrote!

    Not only is the discussion of value and stewardship an important extension of the doctor/patient relationship, but it also is a way to put the idea of doing no harm back into play. Not only will we save resources by not using tests and unnecessarily, but given that using more care puts patients at risk of misdiagnosis, over-treatment, and therapeutic misadventures, we benefit our patients in many ways by not intervening if do not need to.

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