America’s physicians are embarking on an initiative to cut healthcare costs by ordering fewer unnecessary tests and treatments for their patients. Nine prominent physician groups released lists of 45 common procedures they say are often unnecessary and may even harm patients. According to Kaiser Health News, “The move represents a high-profile effort by physicians to help reduce the extraordinary amount of unnecessary treatment, said to account for as much as a third of the $2.6 trillion Americans spend on healthcare each year. Each of the societies, representing both primary care doctors and specialists, picked five procedures that medical evidence shows have little or no value for certain conditions, and which they say should be questioned by patients and their doctors. The list includes such common practices as routine electrocardiograms for patients at low risk for heart disease, and antibiotics for mild sinus infections.”
Dr. Donald Berwick, formerly the Medicare administrator, called the campaign “a game changer. This could be a turning point if it’s approached with energy,” Berwick said. “Here you have scientifically grounded guidance from a number of major specialty societies addressing a very important problem, which is the overuse of ineffective care.”
“We need to use this opportunity to raise awareness that sometimes overtreatment or testing can be harmful,” said Glen Stream, president of the American Academy of Family Physicians, one of the nine participating physician groups. The Choosing Wisely campaign comes amid efforts – some called for in the Patient Protection and Affordable Care Act (ACA) – to compare the effectiveness of treatments and to change payment incentives to physicians and hospitals to reward quality and penalize inefficiency. But efforts to slow medical spending growth tend to be political, giving rise to fears of healthcare rationing or death panels. “Anytime you are recommending against a test or treatment, people wonder ‘is it for some economic interest?’” Stream noted.
Among the nine groups backing the initiative are the American College of Cardiology and the American Society of Clinical Oncology. The effort is being spearheaded by the American Board of Internal Medicine Foundation (ABIM). Together, the participants represent nearly 375,000 physicians.
Writing in Time, Alice Park says that “Each of the nine professional groups has come up with five tests or procedures that it believes doctors and patients overuse routinely. The American Gastroenterological Association, for example, is recommending against repeat colonoscopies within 10 years of a normal result from a first colonoscopy for patients with no family history of colon cancer. The American College of Physicians is advising against using MRI to image patients any time they complain of generalized low back pain, and heart experts say doctors should stop using stress echocardiograms in routine check-ups for patients who don’t have chest pain or other risk factors for heart disease or heart attack.”
One of the initiative’s goals is to make people “feel empowered to go to their doctor and say, ‘Do I really need this test?’” said Christine Cassel, president of the ABIM and the group’s foundation. John Santa, an internist and the director of the Health Ratings Center for Consumer Reports, said, “I think it’s courageous of cardiologists, internists and family physicians to suggest reducing services that they know generate income for some of their members. I’m sure some of their members won’t be happy.”
According to Dr. Steven Weinberger, CEO of the American College of Physicians, “Most of us feel something like $750 billion or so could be eliminated from the system that we spend on healthcare.” Weinberger said that unneeded diagnostic tests almost certainly account for $250 billion annually. “I talk about this a fair amount around the country, and invariably physicians come up to me and recount their own anecdotes about overuse and misuse of care.”