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‘Choosing Wisely’ initiative joins with medical specialty societies to improve care, reduce harms, and costs of overtesting and overtreating

October 31, 2013

By Andy Koopmans

As U.S. policymakers increasingly focus on ways to provide higher-quality, affordable health care, waste and overuse of health care resources have become a concern. According to the American Board of Internal Medicine Foundation, physicians and hospitals perform far too many duplicative or unnecessary procedures and tests that fail to improve health or quality of life and can actually be harmful as well as costly.

In response, the ABIM Foundation in December 2011 announced its Choosing Wisely® campaign, which encourages national medical-specialty organizations to provide specific, evidence-based recommendations to help guide individualized treatment decision-making.

The National Physicians Alliance piloted the campaign in conjunction with Consumer Reports and nine leading medical-specialty societies to identify the top five commonly used tests and procedures whose necessity should be scrutinized.

The resulting lists of “Five Things Physicians and Patients Should Question” were intended to spark discussion among health care providers and patients about the need—or lack thereof—for many frequently ordered tests or treatments. The goal was to reduce negative patient experiences and medical costs, and provide recommendations that can significantly impact patient care, safety and quality.

Since the first nine Choosing Wisely lists were released in April 2012, more than 40 additional medical-speciality societies have provided lists. Thirty more organizations are expected to provide lists during the 2013-2014 campaign. All of the lists released as part of Choosing Wisely were developed after months of careful consideration and review using the latest evidence regarding management and treatment options within a wide variety of specialties ranging from allergies to vascular medicine.

Scientists at the Hutchinson Institute for Cancer Outcomes Research (HICOR) at Fred Hutchinson Cancer Research Center have been involved in creating the list for the American Society of Clinical Oncology. HICOR is an innovative research institute at Fred Hutch that leverages the scientific excellence and oncology expertise of Hutch scientists to harness health care economics with the goal of reducing the cost and improving the effectiveness of cancer prevention, treatment and therapy.

Dr. Bernardo Goulart is a  medical oncologist and member of HICOR at Fred Hutch.

Dr. Bernardo Goulart says financial incentives and a false perception that “more is better” can drive overtreatment and overtesting.

According to HICOR member and medical oncologist Dr. Bernard Goulart, who specializes in caring for patients with lung cancer and head and neck cancers, the recommendations from the various societies as part of the Choosing Wisely initiative are a good measure to address prevalent concerns about the phenomena of overtesting and overtreatment. “The recommendations I’ve seen have been very sound and could help reduce medically unnecessary but overutilized treatments and diagnostics,” he said.

Reducing waste and potential harm

According to the ABIM Foundation, it is estimated that as many as 30 percent of tests and procedures qualify as wasteful. A 2010 survey of Consumer Reports readers found that among nearly 1,200 healthy 40- to 60-year-old men and women with no known risk factors or symptoms of heart disease, 44 percent had received screening tests for heart disease that were “very unlikely” or “unlikely” to have benefits that outweighed the risks.

Additionally, research published in JAMA Internal Medicine in 2011 in anticipation of the release of the first round of lists found more than $5 billion could be saved if the recommendations of the original nine societies were implemented.

Goulart indicated that while the causes of overtreatment are not clear there are a number of likely determinants that play a role. “We don’t understand exactly the drivers of overtreatment, but it’s likely a combination of financial incentives as well as a false perception by both some physicians and patients that doing more tests is better than doing fewer,” he said. “I think there is a perverse financial incentive in the sense that clinics and physicians are reimbursed by the amount of services they provide and not by the quality or value.”

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