Choosing Wisely: Trimming Fat in the Health Care Industry

In corporations, it's common to implement and continuously refresh best practices to eliminate inefficient, low-value activities. A similar principle is now being applied to the U.S. healthcare industry due to excessive medical spending in the United States. David Cutler, an expert in Economics at Harvard University, suggests that one third—up to $750 billion— of our country’s medical spending does not contribute to improved health. Through a campaign called Choosing Wisely, nine specialty medical groups have identified tests or procedures “commonly used in their field, whose necessity should be questioned and discussed.” The end goal: Reduce costs and improve care. Launched last year by a foundation of the American Board of Internal Medicine, the campaign galvanized around a controversial opinion piece by Dr. Howard Brody, director of the Institute for the Medical Humanities.

Since then, nine medical specialty societies have committed to this campaign and eight more are expected to join this fall. While the Choosing Wisely campaign is not the panacea for spiraling healthcare costs, it is surely a positive step forward in raising awareness about excess spending. Ultimately, by reducing healthcare costs we can ensure that all patients have access to safer, higher-quality care.

The original medical specialty organizations of the campaign, who are leaders in cardiology, oncology, radiology and primary care, last month released their recommendations for areas where healthcare costs can be trimmed. Suggestions include skipping treatments such as cardiac stress tests for annual checkups in asymptomatic patients and brain imaging scans after fainting. Arguably the most controversial recommendation is that oncologists limit or decline chemotherapy treatments for late-stage cancer patients; most oncologists agree that these patients would be better off receiving hospice care.

With reducing health care costs as its core mission, Choosing Wisely has certainly sparked a healthy but contentious debate. One argument against their recommendations is that cutting “waste” could actually be healthcare rationing in disguise. The campaign’s architects make it clear, however, that their fundamental goal isn’t rationing care or denying services to those who need them. Instead, they emphasize that Choosing Wisely is about eliminating care that has no value.

Measures to contain and reduce healthcare costs in this country are vital—especially in this uncertain economy. I support this campaign, not only for its potential to trim costs but also for its ability to fill a gaping void in today’s healthcare system: The troublesome lack of communication between patients and physicians. In addition to making doctors more accountable in their practices, Choosing Wisely’s recommendations also place equal responsibility on patients to ask important questions that may ultimately lead to better care.

The campaign is working with Consumer Reports magazine to broadly disseminate the list of “unnecessary” treatments and procedures; however, for the time being, there is no regulation that forces patients and healthcare professionals to treat these recommendations as rules. I believe it’s up consumers to question procedures that may be unnecessary. It’s really about making well-informed decisions and thinking before we act. After all, every test, necessary or not, has a cost to the system.

I urge you to get involved. Read the lists from the nine partners and use these resources to learn how you can be a smarter patient. Then tell me if you agree or disagree.

Sarah Hurley is a consultant at Greenough. Follow her on Twitter at @Sarah_Hu