Ensure residents provide cost-effective care in a tough economy

By: Julie McCoy February 23rd, 2009

These days, everyone has an eye on the bottom line, including patients. Perhaps you or your residents have noticed more patients asking how much certain medication or procedures cost before deciding on a treatment. Or, maybe you’ve seen an increase in uninsured patients come through the hospital’s door.

Providing cost effective care, a component of the systems-based practice competency, is more important to patients today than ever before. Although program directors and attending physicians most likely convey to residents how to make the best, most budget conscious choices for their patients, how do you know they’ve caught on and are doing it themselves?

James Turner, DO, emergency medicine program director at the Charleston Area Medical Center in West Virginia asked himself this same question and decided to build a component into an OSCE to evaluate this aspect of systems-based practice.

To evaluate whether your residents make the most appropriate and cost effective decisions, consider taking the following steps to develop an OSCE similar to Turner’s:

1. Develop an OSCE during which residents see a patient case through from start to finish–getting the history and physical, order writing, communicating the patient case to an attending physician, and making a diagnosis.

2. Before the residents perform the OSCE, convene a panel of experts, usually attending physicians, and give them a one-page summary describing the patient case residents will encounter. Ask the panel which tests, labs, x-rays, etc,. they would need in order to make an accurate diagnosis. Using their input, create a standard of care, which you will use to grade residents against.

3. Ask the hospital billing department for a modified billing sheet that lists what each procedure costs. (Note: Turner says the hospital may not be able to provide you with exact costs of tests, but they can provide you with a proportionally accurate list that describes the costs in relation to one another. For example, it would tell you that a CT scan costs 400 times what an X-ray costs.)

4. Have the residents perform the OSCE, ordering whatever tests they feel they need to make a diagnosis.

5. Compare the costs of the residents’ orders to the standard developed by your experts. Provide residents with feedback on how they did. Ask them to explain their rationale for ordering-or not ordering- certain tests and show them the difference in costs.

How do you evaluate whether residents provide the most cost effective care to patients in your program?