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The Issue As the nation increasingly focuses on ways to provide safer, higher-quality care to patients, the overuse of health care resources is an issue of considerable concern. Many experts agree that the current way health care is delivered in the U.S. contains too much waste—with some stating that as much as 30 percent of care delivered is duplicative or unnecessary and may not improve people’s health.

It is urgent that physicians and patients work together and have conversations about wise treatment decisions. That means choosing care that is supported by evidence showing that it works for patients like them; is not duplicative of other tests or procedures already received; won’t harm them; and is truly necessary.

The Texas Medical Association is advancing the Choosing Wisely® campaign, an initiative to help physicians and patients talk about avoiding unnecessary care.

The Campaign Choosing Wisely®

Through the Choosing Wisely campaign, TMA is helping Texas physicians spur conversation around evidence- based recommendations created by your medical specialty societies.

District (Metro Health), I am encouraged that they and other clinical and academic physi- cians recognize that a U.S. health care system that disproportionately focuses on “health problems in their advanced stages” is unsustainable, and that resources must be directed away from “high- dollar, low-value services and deliv- ery methods” and toward “public health and pre- vention.” The au- thors credit Code Red 2012 (www

is an initiative of the ABIM Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Recognizing the importance of physicians and patients working together, leading specialty societies, along with Consumer Reports, have joined Choosing Wisely to help improve the quality and safety of health care in America.

Watch the Choosing Wisely CME webinars and earn 3.75 AMA PRA Category 1 Credits™ and 3.75 ethics credits. For a limited time, the Choosing Wisely CME bundle is free at ChoosingWiselyCME. ChoosingWisely/

As part of Choosing Wisely, each participating specialty society has created lists of “Things Physicians and Patients Should Question” that provide specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation.

About the Campaign

have saved the county millions of dollars in avoided medical costs. For example, the Metro Health program “Proj- ect Worth,” which com- bines school-based and

The resulting lists will stimulate discussion about the need—or lack thereof—for many frequently ordered tests or treatments. Participating specialty societies and the ABIM Foundation are using these lists to support physicians in making wise choices and will develop tools to help them have these kinds of conversations with patients.

This concept was originally piloted by the National Physicians Alliance, who through an ABIM Foundation Putting the Charter into Practice grant created a set of three lists of specific steps physicians in internal medicine, family practice and pediatrics could take in their practices to promote the more effective use of health care resources. with popularizing these concepts in Texas and guiding the devel- opment of the Medicaid 1115 waiver, which has since brought down $17 billion in new federal funding to help health care systems improve access, quality, and ef- ficiency and, for the first time, support com- munity mental health and local public health “to push forcefully up- stream along the contin- uum of prevention.” In Bexar County,

Consumer Reports, the nation’s leading independent, non-profit consumer organization, has also joined the campaign to provide resources for consumers and physicians to engage in these important conversations. They are coordinating consumer- oriented organizations to help disseminate information and educate patients on making wise decisions.

Continuing the Professionalism Challenge Choosing Wisely is part of a multi-year effort of the ABIM Foundation to help physicians be better stewards of finite health care resources. It continues the principles and commitments of promoting justice in the health care system through a fair distribution of resources set forth in Medical Professionalism in the New Millennium: A Physician Charter.

Learn more about Choosing Wisely at

Real progress will be made only when clinical medicine and public health work together on upstream solutions.

community-based edu- cation, outreach to phy- sician offices, case man- agement of teen moms, and access to effective contraception in clinics and birthing hospitals, has played a significant role in reducing teenage births, saving about $23 million annually. But perhaps the area

Funded by the TMA Foundation.

$1.1 billion has been al- located and deployed by 25 organizations to fund more than 100 projects through 2016. Metro Health is using its share, $50 million, on prevention programs in teen pregnancy, oral health, tuberculosis, syphilis/HIV, obesity, and diabetes. These up- stream activities already


in which we can have the greatest impact is di- abetes. In Bexar County, 13 percent of adults are diagnosed diabetics; another 5 percent are undiagnosed. Medical advances in dialysis and transplantation, wound care and amputations, and vision preservation are welcome but bare- ly make a dent in this enormous problem. Real progress will be made only, as the authors sug- gest, when clinical med- icine and public health


work together on up- stream solutions. Metro Health hopes to do just that. With support from the Robert Wood John- son Foundation, public health agencies with waiver funding in San Antonio, Houston, and Austin will con- struct profession- al/community co- alitions to identi- fy the key drivers of the diabetes epidemic and cre- ate and execute action plans for primary, second- ary, and tertiary prevention. The decades-long, ris- ing tide of diabe-

tes in our communities demonstrates that what we in the health care system have been doing up to this point indi- vidually, no matter how excellent, is failing. Our hope is that working to- gether with clear focus will succeed.



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