The role of professional medical societies in reducing practice variations.

Abstract

Prologue: As a group and as individuals, physicians — like most professionals—jealously protect their autonomy and prerogatives. They have been slow to examine the implications of the phenomenon of variations on the cost of care. When physicians and professional groups have focused their attention on variations, the concern has revolved around the quality of medical care. One of the professional societies that has most aggressively examined the misuse of medical practices, including variations in its use, has been the American College of Physicians, through its Clinical Efficacy Assessment Project. The director of that project— which was funded largely by a grant from The John A. Hartford Foundation —was J. Sanford Schwartz, a board-certified internist who is also an assistant professor of medicine at the University of Pennsylvania Medical School. Schwartz, who also trained at Penn and served as a Robert Wood Johnson Clinical Scholar, is a firm believer in medicine taking greater responsibility for evaluating the safety and efficacy of medical practice. An evaluation of the colleges clinical efficacy project is underway, but preliminary information suggests that its recommendations are important sources of information for health policymakers and third-party payers in their decision making. While Schwartz believes the medical profession must be centrally involved in any assessment of clinical efficacy, he also advocates the creation of a quasi-governmental body that would assume responsibility for the assessment of medical technologies. This body must not be directly related to a health financing or regulatory agency if it is to be credible in the eyes of physicians, Schwartz maintains.