David W. Baker, MD, MPH; Amir Qaseem, MD, PhD, MHA; P. Preston Reynolds, MD, PhD; Lea Anne Gardner, PhD, RN; Eric C. Schneider, MD, MSc; on behalf of the American College of Physicians Performance Measurement Committee*
* This paper, written by David W. Baker, MD, MPH; Amir Qaseem, MD, PhD, MHA; P. Preston Reynolds, MD, PhD; Lea Anne Gardner, PhD, RN; and Eric C. Schneider, MD, MSc, was developed by the American College of Physicians Performance Measurement Committee: David W. Baker, MD, MPH (Chair); Mary Ann Forciea, MD; Sandra Adamson Fryhofer, MD; Robert A. Gluckman, MD; Catherine MacLean, MD, PhD; Nasseer A. Masoodi, MD, CMD, CP; Keith W. Michl, MD; P. Preston Reynolds, MD, PhD; and Nathan Spell, MD. Approved by the ACP Board of Regents on 14 February 2012.
This article was published at www.annals.org on 30 October 2012.
Financial Support: Financial support for the development of this paper comes exclusively from the American College of Physicians operating budget.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0480.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Baker: Feinberg School of Medicine, 750 North Lake Shore Drive, Chicago, IL 60611.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Reynolds: University of Virginia, PO Box 800761, Charlotesville, VA 22908.
Dr. Gardner: ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.
Dr. Schneider: RAND, 20 Park Plaza Boston, MA 02116.
Author Contributions: Conception and design: D.W. Baker, A. Qaseem, P.P. Reynolds, L.A. Gardner.
Analysis and interpretation of the data: A. Qaseem, P.P. Reynolds, L.A. Gardner.
Drafting of the article: D.W. Baker, A. Qaseem, L.A. Gardner.
Critical revision of the article for important intellectual content: A. Qaseem, P.P. Reynolds.
Final approval of the article: D.W. Baker, A. Qaseem, P.P. Reynolds, E.C. Schneider.
Collection and assembly of data: A. Qaseem, E.C. Schneider.
Baker DW, Qaseem A, Reynolds PP, Gardner LA, Schneider EC, on behalf of the American College of Physicians Performance Measurement Committee*. Design and Use of Performance Measures to Decrease Low-Value Services and Achieve Cost-Conscious Care. Ann Intern Med. 2013;158:55-59. doi: 10.7326/0003-4819-158-1-201301010-00560
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Published: Ann Intern Med. 2013;158(1):55-59.
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Ron Levy, MD
January 9, 2013
The first step in addressing the high cost of health care should be decreasing use of interventions that provide little or no benefit and are of low value.
An alternate view is that whether an intervention provides little benefit and is of low value may depend on whether a patient's life is saved or prolonged by the intervention.
A benefit from the high cost of health care is the high value of lives saved and disabilities averted. Just as the cost of medical research may be justified by successes, so may the cost of diagnostic tests and screenings.
Instead of coping with the high cost of health care by reducing that costand reducing the survivals that tests may facilitate, a better economy might be to save on such costs as smoking, alcohol, soft drinks, advertising and free lunches provided by sales representatives.
Perhaps the use of diagnostic tests, like the use of vitamin supplements, smoke alarms, costly homes and new cars should be decided by an informed public rather than by experts.
Healthcare Delivery and Policy, High Value Care, Prevention/Screening.
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