“In spite of growing concerns over the increasing cost of healthcare in the United States, very little analysis has been done about how cost considerations impact the development of physician societies’ clinical guidelines,” said lead author Jennifer A. T. Schwartz, MD, a fellow at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Medical Center and a visiting researcher at the National Institutes of Health (NIH) Department of Bioethics. “Attention and even controversy have focused on the roles of government, health plans, and individual physicians in managing costs, but medical societies have an important role to play—one that many have not yet embraced.”
The authors examined publicly available clinical guidance and methodological statements produced between 2008 and 2012 by the 30 largest U.S. physician specialty societies—those with 10,000 members or more—to evaluate their approaches to cost consideration. Methodological statements from 17 societies explicitly included costs, and, of those, more than half (53 percent) consistently used a formal system in which the strength of recommendation was influenced in part by costs. Of the remaining 13 societies, 20 percent made no mention of cost, 13 percent implicitly considered cost, and 10 percent intentionally excluded cost from their clinical guidelines.
Among clinical recommendations that cite cost factors, most common was encouraging use of a treatment or procedure because of equal effectiveness and lower cost. Less common was recommending against use of a service because of incremental clinical benefit at a much higher cost.
Schwartz and senior author Steven D. Pearson, MD, a visiting scientist in the NIH Department of Bioethics, urge that evaluation of short-term cost and longer-term cost-benefits to patients and health systems be part of developing clinical guidance, since “the judgment of physician societies is preferable to that of individual physicians ‘rationing at the bedside.’” They write that by promoting the inclusion of cost as a factor in clinical guidelines, medical societies “may be able to help reduce costs, promote quality patient care, and participate in self-regulation.”
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Children’s National Medical Center in Washington, DC, has been serving the nation’s children since 1870. Home to Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is consistently ranked among the top pediatric hospitals by U.S.News & World Report and the Leapfrog Group. Children’s National is a Magnet® designated hospital. With 303 beds and eight regional outpatient centers, Children’s National is the only exclusive provider of acute pediatric services in the Washington metropolitan area. For more information, visit ChildrensNational.org