Wednesday, January 6, 2016

The  Choosing Wisely Campaign to Save Money on Health Care
Physicians can save the health system money by not performing unnecessary or low yield tests and  treatments  and by educating and  encouraging patients not to expect or to demand  these tests and treatments .   
Example of unnecessary and low value  tests and treatments  are antibiotics for colds and upper respiratory infections, annual  physical exams,   routine x-rays and laboratory tests,  CT or MRI scans for every conceivable ache, pain, or symptom,  tonsillectomies,  over the counter medication, and  cosmetic surgical procedures. 
In the U.S.,  it is estimated  the U.S. wastes 30% of health care dollars ,  worth about $900 billion,
In 2012, in concert with Consumer Reports,  the American Board of Internal Medicine (ABIM) persuaded three primary care societies to participate in a Choosing Wisely Campaign.  This  campaign was later expanded.   Today 70 specialty societies participate.   The societies are asked to list the top five tests or procedures their members deem unnecessary or of low value.  They are asked to asked to list “Five Things Physicians and Patients Should Question.”    The intent is to spark discussion about the need for many frequently ordered tests or procedures.
What have we learned from this campaign?  
One,  most societies  willingly engage in the program.  
Two, the most frequently  listed tests and treatments are in these fields: radiology  29%,  cardiac 21%, medications 21%, lab tests 12%, and others. 
Three,  the lists often include tests and treatments outside the participants field.  
Four,  tests and procedures that are high income producers are usually not listed.
Is this campaign useful?   Yes, it sensitizes societies  and their members to low yield testing perceived to be wasteful.  
Does it lower the number of tests performed?  Probably, but I have not seen any data verifying how much the number of tests are reduced.
It is worth noting, that  this kind of educational campaign is part of larger effort to replace fee-for-service medicine with value-based medicine in which physicians are paid on salary and have no financial incentives to order unnecessary tests and in which organizations are paid a bundled-fee for a given diagnosis,  or episode of care, such as a hip or knee replacement.
A recent New England of Journal article on Choosing Wisely is upbeat on the wide participation  by physicians and 70  professional societies.
“Physicians' willingness to sincerely advance professionalism in medicine and to own their role as stewards of limited health care resources will be revealed by physician-led efforts such as Choosing Wisely. General acceptance of this effort to date by physicians and the public is encouraging and probably reflects our enduring trust in physicians as healers and credible leaders of health care reform. This trust must not be squandered; rather, it should be leveraged to restore balance in our nation's health care investment.”

Nancy Morden, MD, et al, from the Dartmouth Institute for Health Policy and Clinical Practice, “Choosing Wisely – The Politics and Economics of Labelling Low Value Care,: NEJM,  February 14, 2014.

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