One of the biggest challenges to healthcare, now and in the future, will be monitoring and controlling costs. This provides a unique challenge for practitioners, because historically, physicians have not placed adequate emphasis on overall patient cost of care.

The reasons for this lack of cost consideration are multifactorial and include social, political, ethical, and legal considerations. However, as the United States moves into a new era of health care, economic cost will be one of the most important components of the “value” proposition.

Recently, this issue has begun to be addressed by both medical professional societies and healthcare organizations. For example, the AAOS—as well as more than half of the 30 largest U.S. physician societies—take cost into consideration when developing clinical practice guidelines. At their 2013 annual meeting, the board of directors of the National Orthopedic Education Society (www.noes.org) agreed to include cost considerations in all future scientific presentations.

Using a similar approach in addressing costs throughout the orthopaedic community would be a simple and effective way to integrate cost discussions in debates about procedures and techniques. It would also help healthcare providers overcome their discomfort in addressing these issues with patients, most of whom are unaware of the cost of health care because their insurance company is negotiating payment rates.

As new generations of patients gain access to medical care, it is the responsibility of physicians to present clinical information that takes into consideration a patient’s expenses. Physicians need to take personal responsibility for considering and educating patients on the cost of their care. A more widespread understanding of healthcare costs by both physicians and patients will not cure the growing economic burden, but will have an enormous impact.

Cost awareness is essential for medical practices to succeed in the changing healthcare environment. When setting new clinical guidelines, organizations and their physicians need to place a greater emphasis on cost-to-benefit relationships, particularly in technology-driven specialties such as orthopaedics.

New technology designed to advance care is recognized as a primary driver of increased healthcare costs. Rapid technologic advances may be readily adopted as “the latest and greatest,” but a sense of caution is needed.

New medical technology may lead to enhanced outcomes, but cost to the patient must be considered before providers adopt and implement new technology. Cost awareness should be on the forefront of every new proposed technique or piece of hardware. Is the increased effectiveness worth the increased cost to patients? Or are the gains so minimal that older, less costly technology will suffice?

Keeping these considerations in mind not only elevates the physician’s awareness of the patient’s burden, but also facilitates a more conversational approach to determining a patient’s course of treatment.

Will physicians make a conscious and purposeful commitment not just to speak about innovative techniques and the implementation of new procedural guidelines, but also to address their economic impact on the lives of patients? Incorporating cost considerations in scientific presentations at orthopaedic meetings and in designing clinical guidelines are two steps that orthopaedics can take to foster the inclusion of more robust cost metrics in the consideration of treatment options.

Sean Mitchell is a third-year medical student at the University of Illinois. John Cherf, MD, MPH, MBA, is a member of the AAOS Practice Management Committee and on the faculty for the 2014 Practice Management Symposium for Practicing Orthopaedic Surgeons.

Disclosure information: Dr. Cherf—Innomed; Breg; Zimmer; Johnson & Johnson, Wolters Kluwer Health–Lippincott Williams & Wilkins

References:

1. Schwartz JT, Pearson SD: Cost consideration in the clinical guidance documents of physician specialty societies in the United States. JAMA Intern Med 2013;173(12):1091-1097. doi:10.1001/jamainternmed.2013.817.
   http://archinte.jamanetwork.com/article.aspx?articleID=1685895
2. Brauer CA, Rosen AB, Olchanski NV, Neumann PJ: Cost-utility analyses in orthopaedic surgery. J Bone Joint Surg Am 2005 Jun;87(6):1253-1259. Review. PubMed PMID: 15930533.
   http://jbjs.org/article.aspx?articleid=27044