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Medical specialties to develop list of unnecessary procedures

The Choosing Wisely initiative aims to educate physicians and patients about questionable tests and reduce wasted health care.

By Carolyne Krupa — Posted Jan. 9, 2012

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Nine medical specialty societies are joining with the American Board of Internal Medicine Foundation and Consumer Reports to curtail waste in health care and improve patient outcomes.

As much as 30% of U.S. health care is squandered on unnecessary tests, procedures, hospital stays and other services, according to the Congressional Budget Office. Such services don't benefit patients, and in some cases may harm them.

Groups participating in the Choosing Wisely initiative will develop a list of questionable tests and procedures, said Christine K. Cassel, MD, president and CEO of the ABIM Foundation.

"In this current health care environment, everyone is concerned about rising health care costs," she said. "It is a time for both physicians and patients to have better information at their fingertips."

U.S. health care spending is projected to reach $4.6 trillion by 2020 and comprise nearly 20% of the nation's gross domestic product, according to the Centers for Medicare & Medicaid Services.

Several factors may contribute to misuse of medical tests and procedures, including a lack of guidelines for many clinical problems, physician habits and patient expectations, said Dr. Virginia L. Hood, MPH, president of the American College of Physicians, which is participating in the effort.

The initiative's goal is to fuel discussion and help educate physicians and patients about responsible allocation of finite health care resources, Dr. Cassel said. Each specialty organization will develop a list of five potentially unnecessary tests and procedures that are costly, commonly used in their specialty, or both. Each recommendation must be supported by research and will be revised as new evidence arises.

The initial list will be available in April, but Dr. Cassel said it will expand over time as other medical specialties join the effort. "We're not done yet. This is just the first nine," she said. "We're very interested in hearing from specialists who may want to participate."

Targeting misuse

Consumer Reports' role will be to help translate the lists for patients, said John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center. The company has done similar work on other health topics, including a February 2011 report rating different heart disease prevention tests.

"We believe that when consumers are patients, they want the right amount of care -- not too much nor too little," Dr. Santa said. "People are especially concerned about care that may not be effective but expose them to risks, directly or indirectly."

Medical specialty organizations participating in the initiative are: the ACP; American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; American College of Cardiology; American College of Radiology; American Gastroenterological Assn.; American Society of Clinical Oncology; American Society of Nephrology; and American Society of Nuclear Cardiology.

The idea for the initiative came from the National Physicians Alliance, which piloted a similar project in 2009. The alliance is a nonprofit education and research organization focused on helping physicians provide high-quality, affordable care.

Exactly how the Choosing Wisely information will be disseminated hasn't been decided, Dr. Cassel said.

"The Choosing Wisely campaign will help patients and health care providers consider the value of care options, a crucial step in addressing escalating costs and ensuring that all Americans have access to high-quality care," said Allen S. Lichter, MD, CEO of the American Society of Clinical Oncology.

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Choosing Wisely initiative (link)

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