NPA Names 'Top 5' Cost Drivers in Primary Care

John Commins, for HealthLeaders Media , May 24, 2011

According to the study, the field testers agreed with the following practices:

  • Family medicine—limit early imaging for low back pain, avoid routinely prescribing antibiotics for sinus infections, avoid ordering electrocardiograms or other cardiac screening in low-risk patients with no symptoms, reserve Pap tests for patients age 21 years or older who have not had hysterectomy for benign disease, and reserve dual-energy X-ray absorptiometry osteoporosis scans for women ages 65 years and older and men 70 years and older or who have risk factors
  • Internal medicine—limit early imaging for low back pain, do not order blood panels or urinalysis for screening in healthy adults with no symptoms, avoid ordering ECGs or other cardiac screening in low-risk patients with no symptoms, limit initial statin prescriptions to generic medications, and reserve DEXA osteoporosis scans for women ages 65 years and older and men 70 years and older or who have risk factors
  • Pediatrics—avoid prescribing antibiotics for sore throats unless tests for streptococcus are positive, limit diagnostic imaging for minor head injuries without loss of consciousness or other risk factors, do not refer middle-ear infections (otitis media with effusion) to specialists too early, tell parents to avoid giving children over-the-counter cough and cold medicines, and ensure that inhaled corticosteroids are used properly by patients with asthma

The NPA plans to distribute the Top 5 lists for each specialty to its members in those fields, create training videos to help doctors communicate the value of these behaviors, and create videos that explain to patients why the steps on the Top 5 lists should be taken, and reach out to consumer groups and patient-safety groups for their endorsements.

Although the study focuses on primary care physicians, Smith says he hopes that specialists will take up the challenge and identify cost-savings and inefficiencies in their own realms. "The specialists have just as much responsibility. But this is where we wanted to start. It seems like a good beginning and hopefully it will lead to other specialists doing the same," he says.


John Commins is a senior editor with HealthLeaders Media.

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1 comments on "NPA Names 'Top 5' Cost Drivers in Primary Care"

Arun (5/24/2011 at 11:41 AM)
NPA 's list is very encouraging for the patients, and third party payers because primarily it makes sense and leads to a major paradigm shift; something the current ACO concept seems to be promoting. What concerns me is the lack of information on the studies showing that reduced diagnostic testing and use of antibiotics actually has no impact on the quality of care patients are conditioned to expect from our physicians. There are individualized studies but combining their outcomes and forming a new practice protocol and getting recommended by the authoritative bodies is missing. Another aspect lacking in this approach is there is no safe harbor for a practitioner if he or she chooses to change the practice protocol and adopt these five Cost Driver reduction suggestions. There has to be strong correlation properly established between the practice without unnecessary testing etc., and prognosis indicating absence of those tests or drugs have actually benefited the patients. After that it has to be legally adopted something like making it a part of " Meeting Medical Necessity" gate-keeping. This will absolve a practitioner from any unfavorable outcomes unrelated to their actions of not conducting certain testing or using drugs and ward off the ever vigilant medical liability chasers; the very reason often given by most physicians for adopting the defensive medicine. The Top 5 Cost drivers are known to the Cost Accountants and Analyst of all payers and medical wisdom is without doubt present but without the fundamental changes in the Medical Mal Practice doctrine, laws and regulations it will be a hard sale to all practitioners.




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