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  • CME Information

Target Audience

Health care providers of all specialties including physicians, nurses, nurse practitioners and physician assistants.

Description

The ABIM Foundation, in partnership with Consumer Reports, has developed and implemented the highly successful "Choosing Wisely®" campaign. Medical specialty societies partnering in Choosing Wisely have published nearly 500 evidence-based recommendations that can be used as critical guideposts for conversations between patients and clinicians about avoiding inappropriate care and helping to create a culture of stewardship of healthcare resources. However, one must recognize that good stewardship of healthcare resources is not only a matter of making sure that clinicians understand evidence-based recommendations, but also a matter of helping clinicians learn how to deliver care differently.

Activity Overview

More Americans than ever before are now on high-deductible insurance plans,1 meaning they have to pay out-of-pocket for at least the first few thousands of dollars of healthcare costs before their insurance coverage kicks in. For the average American, these out-of-pocket costs can be financially burdensome and have led to an increasing recognition that medical care can result in a side effect called “financial harm”.2-4 This financial harm can lead to other negative downstream effects, such as patients avoiding future helpful medical tests, procedures, or therapies; an inability to participate in other health programs; or going without basic needs such as food. Because of higher out-of-pocket costs, patients want to know how much their health care may cost them ahead of time and ways that they can mitigate these costs.5 Using a simple, 3-step framework,6 clinicians can work together with their patients to help address costs of care and reduce financial harm.

  1. The Henry J. Kaiser Family Foundation. New Kaiser/New York Times survey finds one in five working-age Americans with health insurance report problems paying medical bills. The Henry J. Kaiser Family Foundation Website. http://kff.org/health-costs/press-release/new-kaisernew-york-times-survey-finds-one-in-five-working-age-americans-with-health-insurance-report-problems-paying-medical-bills/. January 5th, 2016.
  2. Blumberg, LJ, Waidmann, TA, Blavin, F, Roth. J. Trends in health care financial burdens, 2001-2009. Milbank Q. 2014: 92:1.
  3. Richman, IB, Brodie, M. A national study of burdensome health care costs among non-elderly Americans. BMC Health Serv Res. 2014: 14:435.
  4. National Cancer Institute. Financial toxicity associated with cancer care—Background and prevalence. National Cancer Institute Website. https://www.cancer.gov/about-cancer/managing-care/financial-toxicity-hp-pdq. 2016.
  5. Rosenthal, E. How the high cost of medical care is affecting Americans. The New York Times Website. http://www.nytimes.com/interactive/2014/12/18/health/cost-of-health-care-poll.html?_r=0. December 18th, 2014.
  6. Moriates, C, Shah, NT, Arora, VM. First, do no (financial) harm. JAMA. 2013: 310:6.

Learning Objectives

At the conclusion of this activity, participants will be able to:

  1. Discuss the problem of “financial harm” for individual patients
  2. List the three steps of the “First, Do No Financial Harm” framework
  3. Demonstrate strategies for discussing costs and the value of recommended medical procedures with price-sensitive patients

Additional References

Faculty Information and Disclosures

Vineet Arora, MD, MAPP is the Education Director for Costs of Care, a non-profit that curates clinical insights that drive better care at lower cost. She is also Associate Professor of Medicine, Assistant Dean of Scholarship & Discovery at Pritzker School of Medicine, and Director of GME Clinical Learning Environment and Innovation at the University of Chicago Medicine. Dr Arora is also a Board of Directors member for the American Board of Internal Medicine.

Reshma Gupta, MD, MSHPM is the Outreach and Evaluation Director for Costs of Care. She oversees the joint Costs of Care/American Board of Internal Medicine Foundation Learning Network, which aims to support clinical innovators in scaling and sustaining best practices that improve value. She is the Medical Director for Quality and Value at the Offices of Accountable Care and Population Health at UCLA Faculty Practice Group.

Chris Moriates, MD is the Implementation Director for Costs of Care. He is also the Assistant Dean of Healthcare Value and an Associate Professor at the new Dell Medical School at UT Austin, and previously was an Assistant Professor at the University of California, San Francisco (UCSF), where he directed the center-wide Caring Wisely program and served as co-chair of the UCSF Division of Hospital Medicine High-Value Care Committee.

Danielle Moriates, RN is a nurse advisor for Costs of Care and has been working within the Advocacy platform to better engage nurses in delivering value-based healthcare. She is also a registered nurse who works in the neonatal intensive care unit at Seattle Children’s Hospital in Seattle, Washington.

Neel Shah, MD, MPP is the Founder and Executive Director of Costs of Care. He is also an Assistant Professor at Harvard Medical School and the Ariadne Labs for Health System Innovation. He maintains an active clinical practice as an ob/gyn that includes delivering babies, providing primary care, and performing surgery.

September Wallingford, RN, MSN is the Operations Director for Costs of Care. She currently oversees strategy, execution, and coordination of Costs of Care’s growing programs and works towards enhancing the visibility of the nursing profession in empowering patients and clinicians to deflate medical bills. She is also a registered nurse at Brigham & Women’s Hospital in Boston, Massachusetts.

The faculty have no conflicts of interest to disclose.

The faculty at Costs of Care and the staff of the Center for Continuing Medical Education have no financial relationships to disclose.

Accreditation and Credit Designation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Chicago Pritzker School of Medicine and Costs of Care. The University of Chicago Pritzker School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Chicago Pritzker School of Medicine designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This enduring material is approved for 2 years from the date of original release, March 22, 2017 thru March 21, 2019. To successfully earn credit, participants must complete the activity online during the valid credit period. To receive AMA PRA Category 1 Credits™, the participant must complete the activity evaluation and correctly answer all questions (100% pass rate) on the post-test. The test can be accessed by clicking on the appropriate certificate link at the top of this page. Upon successful completion, the participant may save or print their certificate (PDF).

Nurses and other healthcare professionals will receive a Certificate of Participation. For information on the applicability and acceptance of Certificates of Participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME, please consult your professional licensing board.

Fee

These activities are complimentary.

Contact

If you have any questions regarding this CME activity, please contact September Wallingford, Operations Director, Costs of Care: email september@costsofcare.org or Samantha Anderson, Research Specialist, Section of General Internal Medicine, University of Chicago: email sanderson7@medicine.bsd.uchicago.edu

Grant Funding

Funding for these modules was provided by the ABIM Foundation with support from Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of RWJF.

Disclosure(s) Declarations

As a provider accredited by the ACCME, The University of Chicago Pritzker School of Medicine asks everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. This includes any entity producing, marketing, re-selling, or distributing health care goods or services consumed by or used on patients. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months, including financial relationships of a spouse or life partner that could create a conflict of interest. Mechanisms are in place to identify and resolve any potential conflict of interest prior to the start of the activity.

Additionally, The University of Chicago Pritzker School of Medicine asks authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.

Disclaimer

The information presented in this activity is for continuing medical education purposes only. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of the University of Chicago Pritzker School of Medicine, the University of Chicago Medicine, or any Department or Section.