Practice standards: implications for the internist

Area of Science:

• Medical Practice Standards
• Healthcare Policy
• Clinical Guidelines

Background:

• Increasing pressure for national medical practice standards driven by cost control, malpractice liability, and practice simplification.
• Existing standards developed by professional societies (e.g., anesthesiology, cardiology) aim for academic soundness and clinical utility.
• A secondary goal of standards is to control the use of expensive new medical technologies.

Purpose of the Study:

• To examine the development and implications of national medical practice standards.
• To address concerns regarding the academic nature and clinical feasibility of proposed standards.
• To highlight the need for internist input in standard development.

Main Methods:

• Review of current trends and pressures influencing medical practice standards.
• Analysis of professional society initiatives in standard creation.
• Examination of governmental and third-party payer perspectives on practice standards.

Main Results:

• Standards aim to reduce malpractice liability and monitor quality of care, with federal government interest in cost control.
• Clinicians express concern that standards may be too academic and unrealistic, potentially restricting practice.
• Some evolving standards, like breast cancer screening, may increase costs without proven savings.

Conclusions:

• Physician education is primary, but controlling technology use is a key secondary goal of practice standards.
• Third-party payers are observing standard development but are hesitant to link them to reimbursement.
• Internists must actively contribute to standard development to ensure appropriateness and feasibility in clinical practice.