Choosing Wisely: Physician Groups Make Recommendations to Improve Health Care and Reduce Costs


In an effort to improve medical care in the U.S. and save healthcare dollars at the same time, 70 national physician groups representing all types of medical records have proposed lists of medical tests and treatments that physicians and patients should question. This national campaign, called Choosing Wisely, is a bold move by medical groups who collectively represent hundreds of thousands of physicians.  Currently, doctors are paid more for ordering more tests and diagnostic procedures, so these recommendations do not financially benefit the physicians, but have the potential for reducing the cost of medical care for patients, health insurance companies, and government health programs such as Medicare, Medicaid, and Veterans healthcare.

Recommendations

Here are just a few of the groups’ recommendations:

Hives – Routine diagnostic testing (such as immunoglobulin E (IgE), a skin prick or blood test for allergies) is not recommended for patients with chronic hives, because such testing is usually ineffective at identifying the cause. [American Academy of Allergy, Asthma & Immunology]

Pap Smears – Routine pap smears to screen for cervical cancer are not recommended for women under the age of 21. [American Academy of Family Physicians]

Cardiac Stress Test – Cardiac stress test imaging (a procedure where dye is inserted into the blood stream and images show how well the blood is flowing through the heart) is not recommended for cardiac patients at their annual check-ups unless symptoms are present. [American College of Cardiology]

X-Rays and MRIs for Back Pain – Imaging (X-rays, MRIs) is not recommended for a patient with lower back pain unless a specific cause has been identified. [American College of Physicians]

MRIs and CCTs of the Brain – Imaging of the brain, including MRIs and CCTs (cranial computed tomography), is not recommended for a patient with a headache unless specific risk factors have been identified. [American College of Radiology]

Colorectal Cancer Screening– Colorectal cancer screening by any method (including flexible sigmoidoscopy, computed tomography colonography, double-contrast barium enema test) should be repeated every 10 years in low to average-risk patients who received a normal result at their last colonoscopy screening.  This is less frequently than previous recommendations.  It is recommended that people get their first colonoscopy at age 50. [American Gastroenterological Association]

Breast Cancer Testing – Imaging (PET, CT and radionuclide bone scans) is not recommended for patients with early-stage breast cancer at low risk for metastasis (cancer spreading to other parts of the body). [American Society of Clinical Oncology]

Cancer Screening – Routine cancer screenings (including colonoscopy, mammography and pap smears) are not recommended for patients on dialysis who have a short life expectancy, unless specific signs and symptoms are present. [American Society of Nephrology]

Chest Pains – Routine cardiac imaging including a stress echocardiogram (which  uses ultrasound to show how well the heart is pumping blood) is not recommended for a patient with chest pains who is at low risk for a heart attack or cardiac-related death, is able to exercise, and has a normal electrocardiogram (EKG).[1] [American Society of Nuclear Cardiology]

Consumer Reports has written 120 free pamphlets for patients who want to see many of the Choosing Wisely recommendations:  http://consumerhealthchoices.org/campaigns/choosing-wisely/#materials

How Will This Help?

Healthcare spending in the United States is expected to rise to around $4.6 trillion by 2020 unless major changes are made to eliminate unnecessary procedures, according to the Centers for Medicare & Medicaid Services.[2] An increase in the number of people living with chronic illnesses, rising prescription drug prices, and the high administrative costs of managing healthcare programs will contribute to increasing costs. While many continue to debate the exact reasons why healthcare spending is out of control, most agree that something needs to be done immediately.

In 2011, the American Board of Internal Medicine Foundation (ABIM) and National Physicians Alliance initiated he Choosing Wisely campaign, aimed at decreasing healthcare costs by reducing unnecessary tests and procedures. Each medical specialty group was asked to develop a list of five recommendations based on evidence from research findings. These recommendations were specific to their own medical fields.

Many doctors and health experts understand that more medical care, and more expensive medical care, is not necessarily better medical care.  However, studies show that many Americans mistakenly assume that running more tests and relying on newer, more costly technologies translate into better health (see Is Newer and More Expensive Care Better?) http://www.center4research.org/newer-expensive-care-better/.  Doctors often err on the side of caution by ordering more tests, and there is sometimes a financial incentive for doctors to do so as well.  That’s why the Choosing Wisely Campaign is so important: it relies on experts to urge doctors and patients to avoid tests and treatments that are likely to do more harm than good.

 

All articles have been read and approved by Dr. Diana Zuckerman and other senior staff.

  1. Choosing Wisely: An Initiative of the ABIM Foundation. Accessed April 04, 2012. http://www.choosingwisely.org/doctor-patient-lists/.
  2. Centers for Medicare & Medicaid Services. “National Health Expenditure Projections 2010-2020.” Accessed April 09, 2012.