If I had been given a multiple choice question about the “Choosing Wisely Campaign,” I would not have selected anything related to limiting low-value health services. Yet, this campaign is in fact an effort to have physicians and physician groups develop a focus on becoming better “stewards of finite health care resources.” A short perspective (NEJM 2014; 370: 589-92) on the rollout of this campaign which was launched nearly two years ago details some of the first steps.
In essence, Choosing Wisely promoted by the National Physicians Alliance and funded by the American Board of Internal Medicine has two core objectives (The Choosing Wisely™ Campaign Five Things Physicians and …). The first is a developing lists by specialty societies of low-value tests and treatments (low-value services are often a waste of money) and the second is a patient education component led by Consumer Reports. The authors state that the careful design has avoided negative publicity regarding issues like rationing and undermining the patient-doctor relationship. An alternative explanation could be that the information has not been widely disseminated yet.
The article then details the low-value services that different societies identified. “Participating societies generally named other specialties’ services as low-value…29% of listed items target radiology; 21% cardiac testing; 21% medications; 12% laboratory tests or pathology. Cognitive specialists name very few of their own revenue-generating services.”
Examples of speciality groups that avoided any tough decisions:
- American Academy of Otolaryngology: chose three imaging tests and two antibiotics. It did not select any ENT procedures despite the extensive literature on the overuse of several.
- American Academy of Orthopaedic Surgeons: listed an over the counter supplement, two small durable-medical equipment items and a rare minor procedure (needle lavage for osteoarthritis of the knee). No major procedures were selected.
While atypical, some organizations did identify potential low-value services which were more meaningful:
- Society of General Internal Medicine: their list included the annual physical
- American Gastroenterological Association: their list included three specific endoscopic procedures, including not performing a repeat colorectal cancer screening within 10 years of a high-quality exam (Choosing Wisely • American Gastroenterological Association (AGA)
While the initial goals of Choosing Wisely were “not intended to inform cost-containment efforts and quality measures,” ultimately, when physician groups can identify low-value services, these will be targeted with financial incentives or with quality measurement tools.
Take home message: Choosing Wisely campaign is a start towards identifying tests, medicines, and procedures that are often unnecessary. However, most physician organizations have not identified low-value services that would affect the revenue streams for their members.
Related link from Atul Gawande’s twitter feed: http://t.co/JtZWKRpGJp
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