STS Leader Contributes to IOM Report


STS News, Winter 2013 -- This past September, the Institute of Medicine released a report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” which lays out a comprehensive plan for moving the country toward a more efficient and effective health care system.

T. Bruce Ferguson Jr., MD, Chair of the STS Workforce on Health Policy, Reform, and Advocacy, served on the Committee on the Learning Health Care System in America, which developed the report.

The project was borne out of the IOM’s realization that the US health care system cannot continue along its current path. The committee estimated that in 2009, $750 billion—about 30% of health spending nationwide—was spent on unnecessary services, excessive administrative costs, fraud, and other problems.

The report details 10 recommendations for building a health care system that learns from past mistakes to improve quality, outcomes, and cost. The recommendations range from developing an infrastructure for collecting clinical data, to better involving patients in medical decision making, to restructuring payment models to reward effective, efficient care.

“Systems need to be developed within health systems to not only manage patients from a quality point of view, but also from a cost and care delivery efficiency point of view,” Dr. Ferguson said.

Participation of medical specialty societies like STS is essential to implementing the report’s recommendations, he said.

“There’s a very real opportunity here to leverage the assets that professional medical organizations can bring to the table. STS in particular, with our resources like the STS National Database and our experience collaborating with the American College of Cardiology, is perfectly positioned to play a very important role,” Dr. Ferguson added.

One IOM recommendation encourages medical specialty societies to increase transparency on the quality, value, and outcomes of the care provided by their members—a goal that STS is already working toward with STS Public Reporting Online and the Consumer Reports public reporting initiative.

Another recommendation encourages organizations to develop and promote evidence-based clinical practice guidelines. The Society’s Workforce on Evidence Based Surgery has spent many years developing evidence-based guidelines that provide practical assistance to STS members. Currently, 15 STS-generated clinical practice guidelines are available at

“The report contains many challenges for STS and its members as well. Full and complete transition to a delivery system with the patient firmly at the center of focus requires a re-engineering of past perceptions and practices,” Dr. Ferguson said. “Determining how to integrate the STS National Database into the era of electronic health records and ‘Big Data’ will be a challenge as well for all organizations with clinical database assets.”

Dr. Ferguson explained that the next steps are for health care system stakeholders to carefully evaluate the report and determine how they can move in this direction. The IOM Roundtable on Evidence-Based Medicine will function in an ongoing supervisory role in the rollout, implementation, and adoption of the report.

The full report can be accessed at