Cost Conscious Care Committee: Using a Modified Nominal Group Technique to Reduce Wasteful Spending at an Academic Internal Medicine Residency

Background:

It is estimated that 30% of US healthcare cost is wasteful spending. In order to reduce this cost, there have been initiatives by SHM (evidence based recommendations), ABIM (Choosing Wisely campaign), and ACP (High Value Cost Conscious Care curriculum). In line with these measures a Cost Conscious Care Committee (CCCC) was created at Hofstra North Shore-LIJ Internal Medicine residency to identify and act on barriers to providing cost-effective care.

Purpose:

To reduce wasteful spending by the Internal Medicine residents at North Shore and Long Island Jewish (LIJ) hospitals.

Description:

At a class meeting in February 2014 a modified nominal group technique was used where the residents were asked ‘What prevents you from practicing cost conscious care?’ Nine barriers were identified and of these, two were selected as the most actionable. The first was the ease with which the electronic medical record allows recurrent labs to be ordered and the second was the limited knowledge of tests’ costs. With the barriers identified the CCCC, a resident-led group with guidance from the faculty, was created. Recurrent labs were tracked for seventeen resident-led teams, at two campuses (North Shore and LIJ), over a nine week period prior to intervention. At the start of the 2015-2016 academic year, a member of the CCCC spoke at morning report on both campuses about how recurrent labs could unintentionally extend patients’ length and cost of stay. The residents were told they would not be subject to penalty if they ordered recurrent labs, but were asked to consider every order daily. Three months after intervention the preliminary data shows a downward trend in recurrent labs. In order to act on the limited knowledge of tests’ costs the CCCC tabulated the prices of the most frequently ordered labs and imaging studies, and is in the process of creating a laminated index card with this information for the residents to carry.  

Conclusions:

Creation of the CCCC has empowered the residents to self assess and reduce wasteful spending in the residency. Since its creation in March 2014 there has been a decline in recurrent laboratory ordering on admission. Going forward it is the committee’s goal to educate the residents on the costs of commonly ordered studies and to act on more of the nine identified barriers.