“Most of these recommendations are not news to people. The reason to focus on them is they remain commonly done, despite common knowledge that they are frequently unnecessary.”
Susan Strate, MD
specialty medical societies compiled their lists of 45 tests and procedures. (See “Specialty Societies Identify Over- used Procedures,” opposite page.) Now, the Texas Medical Association is joining other state and national medical societies in considering a partnership of sorts. At the TMA Fall Conference in Oc- tober, the TMA Council on Health Care Quality voted to support the campaign. The action awaits final approval by the TMA Board of Trustees. A recent report from the Institute of Medicine estimates that up to 30 percent of U.S. health care spending goes toward unnecessary tests, procedures, hospi- tal stays, and other inefficiencies. Often, such ser- vices don’t ben- efit patients and in some cases may harm them, says Christine K. Cassel, MD. The Philadel-
26 TEXAS MEDICINE December 2012
phia internist and geriatric medicine spe- cialist is president and chief executive of- ficer of the American Board of Internal Medicine (ABIM) and the ABIM Founda- tion, which created Choosing Wisely. The campaign aims to help patients
and physicians weigh the value of vari- ous care options. That’s a critical step toward not only addressing escalating costs, but also ensuring that patients are getting high-quality care, she says. “This is a way of getting research-based infor- mation that’s timely and current to both doctors and patients. We haven’t actually had a good way of doing that.” Comparative effectiveness and evi- dence-based research have their place, but patients’ eyes tend to glaze over at the sound of such discussions, Dr. Cas- sel says. By making such information more accessible, “maybe we can change the culture and the mindset that ‘more is better,’ and once we get out of that mindset, it really becomes more of a question of what is valuable care.” TMA continues to develop educa-
tional materials and clinical tools to help physicians answer that question. It is evaluating the Choosing Wisely cam- paign’s potential as yet another vehicle to ready physicians for upcoming qual- ity improvement, patient safety, and performance measurement challenges, says Wichita Falls pathologist Susan M. Strate, MD. She is vice speaker of the TMA House of Delegates and a former member of the TMA Council on Health Care Quality. “As health system reform catapults ahead, there are a lot of changes com- ing at doctors like a tsunami, and it’s clear that payment in the future is going to be linked more to value, rather than just volume,” said Dr. Strate, who also serves on the Texas Institute of Health Care Quality and Efficiency Board of Di- rectors. The governor-appointed board was established by a 2011 state law to improve health care quality in the state through methods such as care coordina- tion models, quality measures, and data collection. Quality and cost initiatives tied to forthcoming system changes must be physician-led, and the Choosing Wisely campaign appears to have cleared that important hurdle, she says. “Physicians are uniquely capable of determining what’s best for the patient. They are the ones with the most exper- tise on quality and should be leading that effort. These [Choosing Wisely] lists have been vetted and approved by doctors, and it sets up an opportunity for doctors and patients to really look at some of these treatments and dialogue about them,” Dr. Strate said.
Targeting misuse Prompted by Dr. Brody’s NEJM article, the National Physicians Alliance (NPA) was the first to publish a list of overused tests and procedures in primary care — internal medicine, family medicine, and pediatrics, specifically — to help phy- sicians promote more effective use of health care resources. The ABIM Foundation also wanted as many medical specialties as possible to run with the idea. And they did so vol- untarily, Dr. Cassel noted.
The American Medical Association
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