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Objectives: Estimating cardiac risk is important for preoperative evaluation, and several risk calculators incorporate the American Society of Anesthesiologists (ASA) physical status score. The purpose of this study was to determine the concordance of ASA scores assigned by general internists and anesthesiologists and assess whether discrepancies affected cardiac risk estimation., Methods: This observational study included military veterans evaluated in a preoperative evaluation clinic at a single center during a 12-month period. ASA scores were recorded by General Internal Medicine residents under the supervision of a General Internal Medicine attending, performing a preoperative medical consultation, and were compared with ASA scores assigned by an anesthesiologist on the day of surgery. ASA scores and Gupta Cardiac Risk Scores incorporating each ASA score were compared., Results: Data were collected on 206 patients, 163 of whom had surgery within 90 days and were included. ASA scores were concordant in 60 patients (37.3%), whereas the ASA scores were rated lower by the general internist in 101 (62.0%) and higher in 2 (1.2%). Interrater reliability was low (κ = 0.08), and general internist scores were significantly lower than anesthesiologist scores ( P < 0.01). Gupta Cardiac Risk Scores were calculated for 160 patients, and they exceeded 1% in 14 patients using the anesthesiologist ASA score, compared with 5 patients using the general internist score., Conclusions: ASA scores assigned by general internists in this study were significantly lower than those assigned by anesthesiologists, and these discrepancies in the ASA score can lead to substantially different conclusions about cardiac risk.

The article offers insights on potential ethical tensions inherent to the concept of high-value care education. Topics covered include the different ways to increase value, the need to navigate tension between physicians' commitment to providing cost-effective care while maintaining the primacy of patient welfare and the implications of instilling a primary commitment to patient welfare in cultivating professional identity.

A response from the authors of the article "Providing price displays for physicians: Which price is right?," is presented.

The authors discuss the price transparency in health care. Topics discussed include the price transparency as one way to address the cost crisis in the U.S. health care system, sources to consider for displaying the price of certain tests for physicians and the authors' suggestion to consider some ethical issues to guide the design and implementation of providing price displays to physicians.