Guidelines and protocols created by professional societies are common in American
hospitals and health plans use these guidelines for quality improvement and cost
management (Woolf, et al., 1999). a I do believe that government should be in a position to
issue physician practice guidelines based on cost efficiency, however, with several
stipulations.
First, the guidelines by the government should be created by expert physicians
from the specific field that the guidelines are being created for. Additionally, the
guidelines should be just that, guidelines…and not set in stone. “Clinicians, policy
makers, and payers see guidelines as a tool for making care more consistent and efficient
and for closing the gap between what clinicians do and what scientific evidence supports
(Woolf, et al., 1999). There are always unique cases and varying situations that may
require the physician to work outside those guidelines in order to do what it best for the
patient. Lastly, the guidelines should be evidence based produced by subject matter
experts and medical societies that have been accredited and understand the particular topic
well.
There are many benefits to having these guidelines in place. These guidelines may
also offer benefits to patients, as the consumer versions are accessible to the public and
patients will be more informed about what their providers should be doing (Woolf, et al.,
1999). Additionally, guidelines can help call attention to certain health problems that are
not as common and offer preventative interventions to underserved patient populations
and high-risk patients (Woolf, et al., 1999).
Pay for performance is an approach that Medicare is seeking for various care
settings including hospitals and nursing homes (Shi & Singh, 2019). This essentially
means that Medicare will pay more based on quality of care versus fee -for-service (Shi &
Singh, 2019). Based on this and the factors indicated above, if the government has the
best interest of the patients in mind, then there should be some say on guidelines.
References:
Shi, L. & Singh, D. A. (2019). Essentials of the U.S. Health Care System (5th ed.). Jones
& Bartlett Learning. Burlington, MA.
Woolf, S. H., Grol, R., Hutchinson, A., Eccles, M., & Grimshaw, J. (1999). Clinical
guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ
(Clinical research ed.), 318(7182), 527–530. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114973/
