Thursday, 20 February 2014

NICED: a new adjective in the medical lexicon

Are healthcare costs sustainable? Is NICE the thin edge of global wedge? #MSBlog #MSResearch

"You have probably guessed that the NICE's decision yesterday regarding BG12 or DMF (Tecfidera) is about economics. Is the drug cost-effective or not and how much lower can NICE drive down the price of drug for UK MSers? You may be interested read the following article of how the US are beginning to tackle their unsustainable healthcare bill, of which MS DMTs are a significant part of."



Excerpts:

..... With its Choosing Wisely campaign, the American Board of Internal Medicine (ABIM) Foundation boldly invited professional societies to own their role as “stewards of finite health care resources.” Beginning in 2009, the National Physicians Alliance, funded by the ABIM Foundation, guided volunteers from three primary care specialties through the development of “Top Five” lists — specialty-specific enumerations of five achievable practice changes to improve patient health through better treatment choices, reduced risks and, where possible, reduced costs..... 

..... In April 2012, the effort was expanded and launched as the Choosing Wisely campaign, with lists from nine specialty societies and a patient-education component led by Consumer Reports. The vision was for societies to develop lists entitled “Five Things Physicians and Patients Should Question” to “spark discussion about the need — or lack thereof — for many frequently ordered tests and treatments.”......

...... The message, the messenger, and the method are key features of this stewardship initiative. The creators of the Choosing Wisely campaign have carefully crafted a recommendation for “conversation” emphasizing individual patients' needs as the top priority, preserving the preeminence of physician judgment, patient choice, and the therapeutic dyad. Doctors and their societies, not payers, develop the lists. As testimony to its careful design, the initiative does not appear to be generating concern about rationing or undermining the patient–doctor relationship, as past efforts to reduce health care overuse have tended to do ......

..... Participation in the program and the choice of items listed convey much about the societies and their members' inclination to embrace the stewardship challenge. On the surface, the creation of low-value–service lists suggests that physicians are willing to make recommendations to improve health care value even against their own financial interests.....

...... The ABIM Foundation's campaign was not intended to inform cost-containment efforts and quality measures, but the physician-endorsed low-value labels will probably be leveraged for these purposes. Payers may use lists to inform coverage, payment, and utilization-management decisions. We believe that if such efforts are designed and applied carefully, they should be embraced as a promising method for reducing use of low-value services.....

...... Ideally, the public education campaign will be intense and sustained, so that the full burden of communication does not fall on limited patient–doctor conversations that are already strained by competing priorities. Public reporting at the physician-group, regional, or hospital level may accelerate practice change, reward physicians who avoid low-value services, and simultaneously inform patients about physicians' practice styles.....

..... Physicians' willingness to sincerely advance professionalism in medicine and to own their role as stewards of limited health care resources will be revealed by physician-led efforts such as Choosing Wisely. General acceptance of this effort to date by physicians and the public is encouraging and probably reflects our enduring trust in physicians as healers and credible leaders of health care reform. This trust must not be squandered; rather, it should be leveraged to restore balance in our nation's health care investment......

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