ACP guidelines urge a closer look at the value of healthcare

The ability to control healthcare costs depends on providing the best value of care, according to the American College of Physicians (ACP) clinical guidelines committee.

In attempt to develop clinical practice guidelines, the committee plans to address whether it is possible to control costs while maintaining or improving quality of care, as well as how clinicians can contribute to the delivery of high-value healthcare. A recent report published in Annals of Internal Medicine provides recommendations for determining value.

Physicians should use three assessment tools, the committee says. First is to determine the benefits, harms, and costs of the care. Physicians should weigh the potential improvements in the patient's health and quality of life, as well as the potential problems that can arise from the care and whether a test or intervention is necessary.

The second step is to determine costs, taking into consideration actual costs of the care as well as those that can arise later as a result of the intervention.

The final step in assessing value is to use cost-effectiveness analysis, which involves comparing possible treatment strategies and the costs associated with each in relation to the benefits that could come from each approach. The ACP suggests using clinical trial data, systematic reviews, and meta-analyses as tools to help determine comparative effectiveness, but cautions providers to take into account adherence rates, which could vary between trial data and real-life statistics. When considering harm, providers should consider the short- and long-term effects of care.

Although the guidelines are still in development, initial steps providers can take include reducing or eliminating care that includes nonbeneficial interventions, such as routine imaging for patients with low back pain.

Guideline critics question whether this level of assessment comes prematurely and without adequate data to judge fairly the value of care.