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October 9, 1996

Effectively Costing Out Options

JAMA. 1996;276(14):1180. doi:10.1001/jama.1996.03540140068030

Physicians who received medical training during the early days of Medicare may recall when patients with newly diagnosed uncomplicated diabetes and hypertension were admitted for leisurely workups. Disputing the attending physician's decision to transfer a patient to the intensive care unit for "observation" may have succeeded only in incurring his or her warth—the issue of cost was seemingly irrelevant at the time. Cost-effectiveness not taught on rounds.

See also p 1172.

That medical education milieu likely did not preprare many of today's clinicians for making decisions about medical care costs, and caring for patients' needs more appropriately the physician's first concern. How infuriating it is to have expended considerable mental and emotional resources in a difficult case, only to be second-suggestand badgered about the cost by an insurance company or utilization reviewer.

However, the reality is that cost has to be dealt with. For example, based onrojections put forth by federal analysts, Peterson1 suggests that if program operations continue as currently, by the year 2030, there will be a combined cash deficit of $1.7 trillion for Medicare Hospital Insurance and Social Security.