The results of a physician survey published this week in JAMA show that a majority physicians look to lawyers, insurance companies, drug and device manufacturers and even patients to bear the responsibility of controlling health care costs. Of the participants, only one-third report that individual practicing physicians bear the same major responsibility. Additional results show that physicians are hesitant to support bold steps that could have meaningful effects on controlling health care costs.
In an editorial accompanying the results of the new survey, lead author, Ezekiel J. Emanuel, MD, PhD, chair of the department of Medical Ethics and Health Policy and the Diane v.S. Levy and Robert M. Levy University Professor and Vice Provost for Global Initiatives at the Perelman School of Medicine at the University of Pennsylvania, emits a call to action, urging physicians to lead what he calls "'an all-hands-on-deck' moment in the history of health care." Emanuel is available for comment on the new survey's findings.
Though there is no single policy that will solve the problem of health care costs, Emanuel and co-author Andrew Steinmetz, BA, suggest six ways in which health care must be transformed in order for reform to take effect: more cost consciousness in medical decisions; increased emphasis on keeping patients healthy; increased team-based care; organized and coordinated systems; process standardization; and greater price and quality transparency. If physicians oppose these six changes, as survey results suggest, the authors say reform will fail.
Emanuel's editorial explores myriad changes that would affect health care costs and the relative support garnered by participating physicians. Major steps that would help to reengineer incentives in the system - including eliminating fee-for-service payment models, and penalizing physicians for avoidable readmissions - received minimal support from participants. More moderate changes - which Emanuel calls "sufficiently vague" - were embraced by the group surveyed. For example, 75 percent of participants supported promoting continuity of care, a reform Emanuel and Steinmetz say has not proved to reduce costs.
"Ultimately, what this survey tells us is that physicians acknowledge that health care costs are an issue, but they are not yet willing to accept primary responsibility and take definitive action to lead change," Emanuel said. "The rejection of transformative, bold solutions to address the seriousness of the cost problem is indicative of much bigger problems ahead of we don't start seeing more leadership from the physician community."
Despite what the authors call largely "discouraging" results, physician participants did seem open to a few reforms that could help lead the system down a path of becoming more cost conscious including limiting access to expensive treatments proven to have little net benefit, and implementing decision-support tools into electronic records to show possible costs of tests and treatments.
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