Teaching Value and Choosing Wisely: Innovation at the American College of Physician’s Centennial Event

ACPCentennialAs the American College of Physicians (ACP) celebrates its 100th anniversary, physicians and healthcare providers from across the country will meet at the Boston Convention Center for the ACP Excellence in Medical Education conference.

Part of this event, which will meet from April 28- May 2, 2015, involves a session titled “Award-Winning Innovations in High-Value Care.” At this session on April 30th from 11:15-12:45, our own 40 Under 40 member Neel Shah of Costs of Care will present with members of the ACP. They’ll share inspirational stories from the front lines of healthcare delivery and audience members will hear presentations from winners of this year’s Teaching Value and Choosing Wisely competition.

“For too long, we’ve been told that when it comes to American medicine, surely, we can do better,” says Ali Khan, MD, MPP, FACP. Khan is a member of the ACP Board of Regents. “We’ve read articles, attended lectures and held forums making the case for value-based care delivery. Now, however, those words are being bolstered by action – on the ground, at institutions all across the country, led by talented health professionals with the creativity and drive to affect the collective change we seek. Award Winning Innovations isn’t about making the theoretical case for value – it’s about sharing the best work being done nationally to make that case a reality. For anyone interested in getting stuff done, there’s no better place to be.”

One former winner of the competition, Giffin Dautridge, a University of Pennsylvania medical student, chatted with us this week to clue us in on his innovative idea: an advanced elective course for medical students on costs of care.

Q: What was the biggest thing you learned by creating this elective, which required calculations of an ideal care plan and the actual cost of patient care?

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Dautridge is now a 3rd year medical student at the Perelman School of Medicine at the University of Pennsylvania

Creating the elective gave us invaluable insight into the cost and quality components of the value equation at University of Pennsylvania. By collaborating with the Chief Medical Officer and his high value team at UPenn, we were given access to the UPHS charge master as well as to the itemized charges that multiple patients had received after being treated at Penn. This granularity of information inspired us to compare treatment strategies between different medical teams to see which was carrying out the highest value care. Ultimately, we learned that the best way to analyze value was by itemizing the costs that make up an episode of treatment and that comparing intervention options allowed for optimizing cost and quality.

Q: You won this award in 2013. Is the course still running?

We’ve slightly modified the proposal that won the TVCW competition. Instead of comparing the ideal and actual care for one patient, we designed an exercise where students would select a clinical condition, design an “ideal” care algorithm based on the literature, and then select two clinical teams and compare their management of that condition by looking at each diagnostic and therapeutic intervention that their patients received, and comparing the charge master cost for each of those.

One student, Sally Liu Baxter and her mentor, Vivek Ahya, completed the exercise. She compared admissions for COPD exacerbations and their management in patients cared for by the hospitalist versus the pulmonology teams. Based on her research, she made multiple recommendations for improving the value of COPD exacerbation care. For example, she found that majority of patients received IV Levofloxacin, when PO is significantly cheaper and that majority of those patients did not have a dietary restriction.

The course and Sally’s research provided us great insight into the value of research itemized by condition in identifying targets for improving value. We stopped running the course because the logistics of administering it for multiple students were daunting to scale, but it inspired me to pursue a price transparency tool that builds a medical menu for doctors so that they can compare treatment options by charge. I hope to make this tool available to medical trainees to facilitate conducting the value exercise that Sally did on a larger scale. I will also be presenting the findings from Sally’s research project at the Academy Health annual research meeting this year as an abstract.

Q: How did winning the Competition help your cause?

Winning the competition is what really got me interested in pursuing ways to improve high value care practices for medical trainees. The competition motivated me to design the value exercise and ultimately is what led me to the work I have been doing on the medical menu app.

Q: Why are you excited about the winner presentations for this year?

I know how much the competition motivated me to engage high value care and how many doors it has opened. It is exciting to think that 6 more teams and individuals will have the same experience and are developing their ideas as a result of the competition this year.

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Register now for the ACP conference. If you can’t make the live session, you’ll be able to watch high quality videos online after the event at acponline.org.

Jenni Whalen

Jenni Whalen

    Jenni Whalen is the Executive Assistant of Editorial at Upworthy. She was previously MedTech Boston's Managing Editor and has an MS in Journalism from Boston University, as well as a BA in Psychology from Bucknell University. Whalen has written for Greatist, Boston magazine, AZ Central Healthy Living and the New England Journal of Medicine, among other places. She has also worked as a conference planner, ghost writer, researcher and content developer.

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