Recognizing that more is not always better health care, five years ago, the American Board of Internal Medicine Foundation and Consumer Reports launched the Choosing Wisely initiative to curb overuse of unnecessary and potentially harmful services. The goal of this initiative is to improve health care value for patients, and reduce harm and costs. The initiative began with about nine medical specialty societies, including the American College of Physicians, the American College of Cardiology, and the American College of Radiology.
The effort has since grown to more than a dozen specialty societies identifying nearly 500 common medical tests and procedures that might not have clear benefits for patients and should sometimes be avoided. Consumer Reports developed patient-friendly educational materials, and providers can take advantage of a suite of education modules to help them engage in these discussions with patients. Choosing Wisely aims to encourage discussions and shared decision-making between clinicians and patients by helping patients choose care that is:
- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary
The results are in – and they show the potential to save costs and improve outcomes through targeting overuse:
After five years, results are starting to show the initiative has made a difference in targeting overuse of unnecessary and low-value health care. A recent article in Health Affairs indicates that Choosing Wisely has resulted in a small reduction in low-value imaging for back pain. Back pain is common and costly, both to the health care system and to patients in terms of out-of-pocket costs. Harvard Medical School in Boston compared commercial insurance claims filed two years before the Choosing Wisely campaign, to claims filed two years after. It found that low-value imaging – including X-rays, computed tomography, and magnetic resonance imaging – fell four percent.
The five largest health systems in California have integrated Choosing Wisely into their systems and have released some early results as well. Cedars-Sinai incorporated almost 100 Choosing Wisely recommendations into their electronic health records, and found that physicians who followed all of the prompts had patients with fewer medical complications and who left the hospital sooner. When physicians fully followed the recommendations, costs dropped by hundreds of dollars per patient encounter. As a whole, the hospital reported a $6 million dollar drop in health care spend over the first full year. The University of Southern California Medical Center and the University of California Los Angeles aimed to integrate the recommendations around low-value preoperative care such as blood tests and electrocardiograms for cataract surgery patients. Results are showing that the reduced testing freed up staff, and provided six months of additional good vision to patients by shortening their wait time for surgery.
The Sharp Rees-Stealy Medical Group in San Diego gave out wallet cards to patients listing “5 Questions to Ask Your Doctor” before getting any test, treatment, or procedure, as well as engaging community skilled nursing homes with the initiative. This group saw a 10 percent decrease in opioid prescribing in one year, and a five percent drop in unnecessary cardiac stress tests. Sutter Health in Northern California addressed more than 130 of the recommendations, and engaged more than 3,000 clinicians treating one million patients in Choosing Wisely efforts. Their work yielded a $66 million drop in spend since 2010, by avoiding unnecessary tests and treatments. Repeat labs have also dropped by 20 percent.
This weekly series explores innovative breakthroughs and new technologies that are driving momentum and change in the life sciences and health care industry.