In response to growing evidence of waste and unnecessary utilization in the health care system, the ABIM Foundation has partnered with nine medical societies and Consumer Reports to identify and reduce inappropriate use as part of its new Choosing Wisely campaign. By identifying the tests and procedures that are most likely to be overused or misused, the initiative hopes to engage hospitals, physicians, and patients in reducing inappropriate care.
First announced in March 2011, Choosing Wisely has enlisted nine medical specialty societies to date, although the ABIM Foundation hopes the program will continue to expand. Underscoring the intense scrutiny that has been placed on the appropriateness of cardiovascular services in particular, the specialty is well represented in the campaign through participation of the American College of Cardiology (ACC), the American Society of Nuclear Cardiology (ASNC), and (to some extent, given the prominence of imaging in CV diagnostic services) the American College of Radiology.
In a December press release, ACC president Dr. David Holmes, Jr., and ASNC president-elect Dr. John Mahmarian both expressed their support of the campaign and acknowledged the responsibility CV leaders have to effectively and appropriately use the tools and technology available to cardiology today.
The full list of current participants in Choosing Wisely is:
- American College of Cardiology
- American Society of Nuclear Cardiology
- American College of Radiology
- American Society of Clinical Oncology
- American College of Physicians
- American Academy of Allergy, Asthma & Immunology
- American Academy of Family Physicians
- American Society of Nephrology
- American Gastroenterological Association
- Consumer Reports
Creating a 'top five' list of unnecessary services
As a first order of business, each participating society has been asked to create an evidence-based list of the top five tests or procedures commonly used in their specialty that physicians and patients should question due to their potential inappropriate use. They were given the following parameters in creating their lists of questionable services:
- Each item should be within their specialty’s purview and control;
- Procedures should be used frequently and/or carry a significant cost; and
- There needs to be evidence to support each recommendation.
Scheduled for release in April 2012, these lists are intended to spark discussion amongst physicians and patients around the necessity and appropriateness of many frequently ordered tests and treatments. Consumer Reports, which has also joined the initiative, has been tasked with developing resources to communicate the group’s findings to patients in order to support shared decision-making between patients and providers.
Supporting the efforts of Roundtable members
Given the Congressional Budget Office’s recent estimate that 30% of health care delivered in the U.S. goes toward unnecessary services (including tests, procedures, medical appointments, and hospital stays), it is clear that efforts are needed to right-size appropriate utilization. That said, it is difficult to anticipate how physicians will respond to initiatives such as the list of top questionable services Choosing Wisely plans to release.
Will the campaign be viewed as an innovative way to educate and engage patients and providers in evidence-based care delivery, or as an imposition on physician autonomy? With this potential pushback in mind, providers will have to be cautious when translating insights gained from initiatives such as Choosing Wisely into clinical decision-making, offering tools that provide clear guidance on appropriateness of tests and procedures, yet without usurping physician judgment.
Given the challenges associated with this mandate, the Roundtable has identified key lessons for embedding evidence-based practice into care as well as ensuring the appropriate utilization of CV services in our latest publication, The New Economics of Quality.
How is your program responding to appropriateness scrutiny?
As the Roundtable continues to monitor the increasing scrutiny over appropriateness of CV services, we would love to hear your perspective on the greatest challenges—and successes—your institution has experienced in this area. Members can share their thoughts by commenting below, or emailing me at email@example.com.
(Krupa C, amednews, 1/9/12)