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Ideas and Opinions |

Lost in Translation: Physicians' Struggle With Cost-Reduction Programs

Howard B. Beckman, MD
[+] Article and Author Information

From Focused Medical Analytics and University of Rochester School of Medicine and Dentistry, Rochester, New York.


Disclaimer: The views presented here are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. The funding source played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Acknowledgment: The author thanks Ellen Leopold for her continuous support and her review and editing of this manuscript, Ron Epstein and Kevin McCormick for their editing suggestions, and Richard Frankel for teaching me how to listen carefully for the words that create meaning.

Grant Support: By The Commonwealth Fund.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2088.

Requests for Single Reprints: Howard B. Beckman, MD, Focused Medical Analytics, 125 Sully's Trail, Suite 8, Pittsford, NY 14534; e-mail, hbeckman@fma-us.com.


Ann Intern Med. 2011;154(6):430-433. doi:10.7326/0003-4819-154-6-201103150-00010
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Relationships between health plans and the medical profession are often strained, leading to the inability to create a shared vision for the health care redesign needed to more effectively care for our population. Because of their respective stakeholders, health plans and providers naturally differ in perspective. However, this article suggests that it is the inability of stakeholders to find a common language to effectively communicate interests, needs, and proposed interventions that often derails progress toward common goals.

The business and health plan leaders' focus on cost-containment and cost-efficiency predictably results in physician defensiveness and disengagement. At the same time, physicians' limited focus on improving quality to only reducing underuse, which in the short term increases costs, does not acknowledge cost concerns of business leaders and health plan executives. However, as divergent as these emphases might seem, there is potential for common ground with effective language translation.

Effective translation has been proposed through the Institute of Medicine's definition of quality as reducing overuse, misuse, and underuse. Creating a common language provides seemingly opposing groups an opportunity to explore a shared vision. Using the language of clinical appropriateness and reducing unnecessary variation has resulted in agreement on clinical quality improvement projects from which each group can return to its own organizations and translate back into its familiar “stakeholder” language.

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