Discussing Tests, Procedures, & Treatments

Health Affairs www.healthaffairs.org held a dialogue on October 24, 2017 in Washington D.C. with leaders in the medical and healthcare field to discuss the progress being made to avoid wasteful or unnecessary medical tests, treatments, and procedures.

The event titled “Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse” pointed out that questions remain on the progress being made and the challenges that still need to be addressed on the issue of waste in the medical system.

“Choosing Wisely” http://www.choosingwisely.org was launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports with funding made available by the Robert Wood Johnson Foundation (RWJF) www.rwjf.org, Susan R. Mende, Senior Program Officer for RWJF, emphasized the need to stop the overuse and waste frequently found in medicine today.

Alan Weil, Editor in Chief for Health Affairs moderator for the briefing, emphasized how important it is for all organizations to understand what works for them, and then tackle the challenges so the concepts can be implemented. It is very important to learn from each other.

As Richard J. Baron President and CEO, American Board of Internal Medicine and ABIM Foundation http://abimfoundation.org pointed out, research has found that nearly three out of four U.S. physicians frequently order unnecessary medical tests and procedures.

He explained, “This occurs because more needs to be done to address some of the other underlying drivers in the healthcare system resulting in perverse payment incentives and how to eliminate unnecessary services. Providers are faced with incentives to provide more care but at the same time, patients have no incentive to avoid care.”

Eric Wei, Interim Chief Quality Officer, Los Angeles County + USC Medical Center, at the Los Angeles County Department of Health Services http://dhs.lacounty.gov, recommends against preoperative medical tests for cataract surgery unless there are specific medical indications.

Dr, Wei reports, “Variations in test results can lead to more unneeded tests prior to cataract surgery because it is considered a low-risk procedure. It has been found that the most of the time preoperative workup has no impact on care. Clinicians are also reluctant to stop unneeded pre-operative tests based on fears of surgical cases being cancelled due to missing pre-operative workups.”

Kaiser Permanente of Washington’s https://wa.kaiserpermanente.org, Matt Handley, M.D., Senior Medical Director for Quality and Safety explained, “Several interventions at Kaiser were put into place to reduce antibiotic use by 35 percent. He said, “More and better conversations need to be held with patients and clinicians to address this specific issue.”

Health Affairs publishing an article for their November issue relates to the Choosing Wisely campaign’s 5 year accomplishments. The article, “Choosing Wisely: How to fulfill the Promises in the Next Five Years”   by Eve Kerr MD, along with Jeffrey Kulligren, and Sameer Saint.

The authors are affiliated with the Center for Clinical Management Research at the Veterans Affairs Ann Arbor Health System and with the University of Michigan http://content.healthaffairs.org/lookiup/doi/10.1377/hithaff.2017.0953

The article discusses the Choosing Wisely campaign’s accomplishments over the past five years and summarizes the steps to take to go forward in the future. The authors suggest there is the need to consistently target the drivers of different types of low-value service utilizations plus there is the need to do more rigorous study designs.

Neel Shah, Founder & Executive Director of “Costs of Care” http://costsofcare.org , a physician-led nonprofit reports, “The goal is to promote better care at a lower cost and also promote and recognize efforts to help residents and medical students learn how to provide appropriate care.

He talked about the importance for teaching and implementing high-value care among collaborative teams of clinicians, educators, quality improvement specialists, and health system administrators.

Other speakers and authors at the briefing included:

  • Arthur S. Hong Assistant Professor, University of Texas Southwestern Medical Center www.utsouthwestern.edu
  • John N. Mafi, Assistant Professor of Medicine, University of California Los Angeles www.ucla.edu
  • Alexander Mainor, Research Project Coordinator, Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth Medical School
  • Jessica Rich, Vice President Consumer Policy and Mobilization, Consumer Reports www.consumerreports.org
  • Kellie Slate Vitcavage, Program Director for Consumer Engagement for Maine Quality Counts www.mainequalitycounts.org
  • Daniel B Wolfson, Executive Vice President and Chief Operating Officer, ABIM Foundation.
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