There has been intensification of interest regarding professional stewardship of health system resources. Public and private plans can no longer increase funding by taxation or premium increases to sustain a relentless rise in expenditures. Two recent publications have gained attention – one of which is very interesting and the other is much ado about not much.
Hype – The Good Stewardship Working Group has put forth an online publication with the Archives of Internal Medicine about the top five issues to reduce risk, harms, and costs.
The material was widely covered in industry and public press, but reading over the materials is a disappointment. Nearly all of the ideas have been in circulation for quite some time and break little new ground. While decision making in the office can be better, these topics will affect costs on the margin and have been the focus of quality improvement and other utilization review interventions over the last 15 years.
Hope – An article by Dr. Thomas J. Smith and Dr. Bruce E. Hillner in the New England Journal of Medicine on methods to bend the cost curve in oncology is timely and thought provoking.
The cancer community has been broaching the topic of value in cancer care over the past few years. This report from a National Cancer Policy Forum workshop highlights several core concepts that inspire rethinking a major cost driver in contemporary medicine. When does chemotherapy represent futile care? How well do oncologists integrate palliative care into their treatment processes? What is the appropriate use of colony stimulating factors to combat bone marrow suppression? The article documents substantial potential gaps in current cancer care and suggests provocative ideas that can result in better stewardship and patient-centered management. It’s a highly recommended read.