High-Value Care

For millennia, physicians enacted their professional mandate to “put the best interest of the patient foremost” by doing everything possible for that patient. Within the past few decades, however, we have learned that doing everything possible is not always in the patient’s best interest. Moreover, the medical profession has come to recognize that physicians have an ethical obligation to be prudent stewards of health care resources. In other words, we simply cannot afford to do everything for every single patient. Therefore, how physicians deliver high-value care that achieves good patient outcomes at reasonable cost, while upholding the primacy of the patient-physician relationship, can prove challenging. Contributors to the November 2015 AMA Journal of Ethics help us think through clinical tensions and ethical dilemmas that surface as physicians endeavor to practice high-value care.

Volume 17, Number 11: 1007-1101 Full Issue PDF
  • From the Editor
    Nov 2015

    The Era of High-Value Care

    Sri Lekha Tummalapalli, MD, MBA
    A new ethos for practicing medicine emphasizes reducing medical errors, minimizing waste, containing costs, and improving adherence to quality metrics.
    AMA J Ethics. 2015;17(11):1019-1021. doi: 10.1001/journalofethics.2015.17.11.fred1-1511.
  • Case and Commentary
    Nov 2015

    The High-Value Care Considerations of Inpatient versus Outpatient Testing

    Josué A. Zapata, MD and Christopher Moriates, MD
    If a medical decision about high-value care involves a conflict between the principles of beneficence and justice, an explicit analysis of the individual case is necessary to ensure that the interests of both the patient and society are served.
    AMA J Ethics. 2015;17(11):1022-1027. doi: 10.1001/journalofethics.2015.17.11.ecas1-1511.
  • Case and Commentary
    Nov 2015

    Grow a Spine, Have a Heart: Responding to Patient Requests for Marginally Beneficial Care

    Bjorg Thorsteinsdottir, MD, Annika Beck, and Jon C. Tilburt, MD, MPH
    Good clinicians understand why a patient is asking for a test or treatment, and their skillful counseling can often stem the tide of requests for marginally beneficial tests and procedures.
    AMA J Ethics. 2015;17(11):1028-1034. doi: 10.1001/journalofethics.2015.17.11.ecas2-1511.
  • Case and Commentary
    Nov 2015

    Cost-Consciousness in Teaching Hospitals

    Maggie K. Benson, MD, MS
    Teaching high-value care requires curricular aids, faculty training, dialogue and teamwork among residents and supervising faculty, and evaluating attending physicians on their practice and teaching of high-value care.
    AMA J Ethics. 2015;17(11):1035-1039. doi: 10.1001/journalofethics.2015.17.11.ecas3-1511.
  • Medical Education
    Nov 2015

    Teaching High-Value Care

    Aditya Ashok and Brandon Combs, MD
    High-value care principles can be incorporated into medical education by training medical students to serve as HVC officers during clerkships and to publish their experiences with the potential or actual harms of medical overuse.
    AMA J Ethics. 2015;17(11):1040-1043. doi: 10.1001/journalofethics.2015.17.11.medu1-1511.
  • State of the Art and Science
    Nov 2015

    The Challenge of Understanding Health Care Costs and Charges

    Vineet Arora, MD, MAPP, Christopher Moriates, MD, and Neel Shah, MD, MPP
    The price transparency movement seeks to make actual medical costs clear to patients and clinicians.
    AMA J Ethics. 2015;17(11):1046-1052. doi: 10.1001/journalofethics.2015.17.11.stas1-1511.
  • Policy Forum
    Nov 2015

    Repeal of the Medicare Sustainable Growth Rate: Direct and Indirect Consequences

    Jeffrey Clemens, PhD and Stan Veuger, PhD
    The Sustainable Growth Rate was replaced in 2015 by the Medicare Access and CHIP Reauthorization Act, which introduced fixed annual physician fee updates and a merit-based incentive payment system.
    AMA J Ethics. 2015;17(11):1053-1058. doi: 10.1001/journalofethics.2015.17.11.pfor1-1511.
  • Policy Forum
    Nov 2015

    Increasing Cost Efficiency in Health Care without Sacrificing the Human Touch

    Eva Luo, MD, MBA
    High-value care can best be achieved by tailoring the delivery of care to the needs of a specific segment of the patient population to improve outcomes and by addressing patients’ needs in an efficient and scalable manner.
    AMA J Ethics. 2015;17(11):1059-1063. doi: 10.1001/journalofethics.2015.17.11.pfor2-1511.
  • Policy Forum
    Nov 2015

    High-Value Palliative Care for Cancer Patients

    Ali John Zarrabi, MD, Ran Huo, MD, and Diane E. Meier, MD
    Although palliative care is high-value because it reduces costs and improves the quality and quantity of life, its implementation is hampered by stigma, a shortage of palliative care specialists, and a lack of adequate palliative care education.
    AMA J Ethics. 2015;17(11):1064-1072. doi: 10.1001/journalofethics.2015.17.11.pfor3-1511.
  • History of Medicine
    Nov 2015

    Promoting Cost Transparency to Reduce Financial Harm to Patients

    Reshma Gupta, MD, MSHPM, Cynthia Tsay, MPhil, and Robert L. Fogerty, MD, MPH
    The escalating costs of health care call for the promotion of cost transparency and physician training on how to discuss medical costs with patients.
    AMA J Ethics. 2015;17(11):1073-1078. doi: 10.1001/journalofethics.2015.17.11.mhst1-1511.
  • Personal Narrative
    Nov 2015

    Countering Medicine’s Culture of More

    Hyung J. Cho, MD
    Countering the prevailing thought that more medical testing and treatment is always better can be achieved by creating a forum for open discussion of costs and value to prevent patient harm from overuse.
    AMA J Ethics. 2015;17(11):1079-1081. doi: 10.1001/journalofethics.2015.17.11.mnar1-1511.