The American College of Physicians (ACP) issued first-of-its-kind guidelines specifically calling for "parsimonious care" Monday.
Listen to the National Public Radio (NPR) interview here.
The 6th Edition of the ACP Ethics Manual is not a Clinical Practice Guideline so no direct implications are implied for physicians' practice patterns.
In other words, physical therapists shouldn't expect the kind of dramatic shifts in patient referral patterns suggested by the Virginia Mason/Aetna or the Intel/Cigna critical pathways much discussed lately.
But, this is the first time that ANY medical society has advised their physician members to consider cost when making patient care decisions. From the Manual:
"In making recommendations to patients, designing practice guidelines and formularies, and making decisions on medical benefits review boards, physicians considered judgments should reflect the best available evidence in the biomedical literature, including data on the cost-effectiveness of different clinical approaches."Some people are concerned about the word "parsimonious". They are concerned that this word has a negative conotation that, in the polarized debate over heathcare reform, could be associated with rationing care. As used in the Manual...
"Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available."For physical therapists, information on the most efficient care will most likely come from comparative effectiveness studies.
In high-volume conditions such as lower back pain and arthritis guidelines will likely support a shift away from routine imaging, invasive testing and surgical treatment.
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