PHILADELPHIA —Today Costs of Care and the ABIM Foundation recognized six innovative projects developed by medical educators to promote high-value care by reducing waste and overuse in health care. The winners of the first ever Teaching Value and Choosing Wisely competition will present their projects at a meeting sponsored by the ABIM Foundation and Josiah Macy Foundation entitled “Advancing the Competency of Stewarding Healthcare Resources in Medical Education and Training” on November 1, as well as the annual meeting of the AAMC on November 2.
Launched in April 2013, the Teaching Value and Choosing Wisely Competition sought to address four goals: 1) identify champions of high-value care in health professions education; 2) characterize solutions for teaching high-value care currently in use by health professions educators; 3) catalyze new ideas and methods for teaching high-value care to trainees; and, 4) help promote promising ideas that can be readily adopted and scaled. All of the entries can be viewed online following free registration at www.TeachingValue.org, and educators can interact and learn from the authors on the new Teaching Value Forum.
The competition was open to clinicians of any discipline and level of training. A panel of experts reviewed more than 70 entries and judged them on metrics including innovativeness, feasibility, and relevance to the current training environment. Winners were named in two categories—“Innovations” for projects that are either completed or underway—and “Bright Ideas” for proposed interventions that were supported by a plan for dissemination to other institutions.
- As emergency medicine residents, Drs. Michelle Lin and Larissa Laskowski created and rapidly implemented a resident-driven cost-conscious care curriculum for trainees at NYU Langone Medical Center and Bellevue Hospital. This effort was inspired in part by real resource constraints that existed after Hurricane Sandy when residents worked in a temporary free-standing Emergency Department based at Bellevue Hospital.
Dr. Robert Fogerty, a faculty member at Yale School of Medicine, created “I-CARE” (Interactive Cost-Awareness Resident Exercise). This exercise engages faculty and trainees in a friendly competition to create effective, lower cost care plans using traditional Morning Report structure and institutional charge data.
- Faculty members Dr. Tanner Caverly and Dr. Brandon Combs created the “Do No Harm” project at the University of Colorado School of Medicine to encourage trainees on an outpatient internal medicine rotation to identify examples of harmful overtesting, overdiagnosis, and overtreatment and write them up as case vignettes. This effort was so successful that it has been adopted into a new journal series at JAMA Internal Medicine called “Teachable Moments.”
Bright Ideas winners:
- Faculty members Dr. Steven Brown and Dr. Cheryl O’Malley from the University of Arizona College of Medicine – Phoenix proposed a high-value care competition for trainees across multiple programs at Banner Good Samaritan Medical Center. Finalists were selected by medical education and hospital administration, and will be given institutional support for implementation.
Giffin Daughtridge, a medical student from the University of Pennsylvania, and his faculty advisor, Dr. Richard Shannon, proposed an advanced elective course for students that included a syllabus of didactic lectures combined with a group “capstone project” that requires calculation of the cost of an ideal care plan for a real patient and comparing this to the patient’s true costs of care.
Dr. Amit Pahwa, a faculty member at Johns Hopkins Hospital, proposed individual dashboards using billing data that would make lab and imaging use for each trainee available for feedback and benchmarking against their peers.
“For the next generation of physicians, the definition of high quality medicine will encompass not only expert diagnosis and treatment but also the respectful management of increasingly expensive health care resources,” said Neel Shah, MD, MPP, Founder and Executive Director of Costs of Care and co-chair of the Competition. “The Teaching Value and Choosing Wisely Competition winners demonstrate a growing movement to identify and cultivate the skills, competencies and organizational support that these aspiring healers will need to fulfill their calling. We encourage others to learn more about these bright ideas and innovations and explore how they might be implemented at their own institutions.”
In addition to Dr. Shah, the Competition was co-chaired by Chris Moriates, MD, Health Sciences Assistant Clinical Professor, University of California at San Francisco and Vineet Arora, MD, MPP, Associate Professor of Medicine, University of Chicago.
“Choosing Wisely® is about ensuring that physicians and patients have critical conversations about what tests and procedures are necessary. It is vitally important to provide the next generation of physicians with the skills they need to actively engage patients in these conversations. These innovations will go a long way in helping us build a generation of physicians that have inculcated reduction of overuse and unnecessary care into their daily practice,” said Richard J. Baron, MD, President and CEO of the ABIM Foundation. “Congratulations and thank you to the winners for contributing these important ideas and innovations that demonstrate how medical professionalism can be a force for change in improving our health care system.”
Teaching Value and Choosing Wisely Competition judges included:
- Paige Amidon, MS, Vice President of Health Programs, Consumer Reports
- Joanne Conroy, MD, Chief Health Care Officer, Association of American Medical Colleges
- Patrick Conway, MD, Chief Medical Officer, Centers from Medicare and Medicaid Services
- Molly Cooke, MD, President, American College of Physicians
- Frank Opelka, MD, President, Physicians Consortium for Practice Improvement
The Teaching Value and Choosing Wisely Competition is supported by an ABIM Foundation grant to Costs of Care and builds on the ABIM Foundation’s Choosing Wisely campaign. Nearly 60 medical specialty societies have joined Choosing Wisely to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Find more information on the campaign at www.choosingwisely.org.