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More than Half of Top Physician Societies Factor Costs into Clinical Guidance

May 17, 2013

Washington, DC — Slightly more than half of major physician societies explicitly consider cost when developing their clinical guidance, according to a study published May 6 online in JAMA Internal Medicine. A few intentionally exclude cost from consideration, but many do not address cost at all.

“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.”

Contact: Emily Hartman or Paula Darte, 202-476-4500

About Children's National Health System

Children’s National Health System, based in Washington, D.C., has served the nation’s children since 1870. Children’s National is one of the nation’s Top 5 pediatric hospitals and, for a second straight year, is ranked No. 1 in newborn care, as well as ranked in all specialties evaluated by U.S. News & World Report. It has been designated two times as a Magnet® hospital, a designation given to hospitals that demonstrate the highest standards of nursing and patient care delivery. This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty outpatient centers in the D.C. Metropolitan area, including the Maryland suburbs and Northern Virginia. Home to the Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is the seventh-highest NIH-funded pediatric institution in the nation. Children’s National is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels. 

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