Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States Cost Consideration in Clinical Guidance Documents

Schwartz JT, Pearson SD. — Mon, 06 May 2013 00:00:00 GMT

Importance

Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis.

Objective

To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies.

Design

Qualitative document review.

Main Outcomes and Measures

Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations.

Results

Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost.

Conclusions and Relevance

Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

Physician Specialty Society Clinical Guidelines and Bending the Cost Curve Comment on “Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States” Physician Society Clinical Guidelines and Costs

Drozda JP. — Mon, 06 May 2013 00:00:00 GMT

For more than 30 years, physicians have heard concerns about escalating health care costs, including warnings of dire consequences from unsustainable trends. Alarms first sounded in 1980 when health care costs rose to 9.2% of the gross domestic product from 5.2% in 1960 and became louder when they jumped to 12.5% in 1990. (These numbers appear almost quaint next to the 2010 figure of 17.2%.) Physicians were criticized because they had the “power of the pen” and were assumed to be the prime movers in all health care spending, and they began to face the ethical conundrum of their dual roles as patient advocates and stewards of health care costs.

JAMA Internal Medicine: Guidelines Topic Collection

Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States Cost Consideration in Clinical Guidance Documents

Physician Specialty Society Clinical Guidelines and Bending the Cost Curve Comment on “Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States” Physician Society Clinical Guidelines and Costs