The Choosing Wisely campaign has brought into the question the necessity of some healthcare services, but do the recommendations have enough teeth to seriously reduce healthcare costs?
According to physicians and academics at Dartmouth and Harvard in The New England Journal of Medicine, Choosing Wisely guidelines could go further.
In 2012, the American Board of Internal Medicine created the Choosing Wisely initiative. Initially, nine physician specialty groups identified five specific tests or procedures they said could be reduced — with the goal of improving patient awareness and safety and helping physicians discern low-value services. As of last year, physician groups have drafted more than 40 specialty-specific lists.
In NEJM, authors wrote the physician-led nature of Choosing Wisely has resulted in a sincere effort for physicians to advance medicine and become "stewards of finite healthcare resources." However, despite the positive start, not all recommendations target areas of high spending.
For example, the authors cited the American Academy of Orthopaedic Surgeons. The AAOS recommended better judgment on tests and use of equipment, but there are no recommendations related to high-cost procedures that could affect their compensation.
"Strikingly, no major procedures — the source of orthopedic surgeons' revenue — appear on the list, though documented wide variation in elective knee replacement and arthroscopy among Medicare beneficiaries suggests that some surgeries might have been appropriate for inclusion," the authors wrote. "Other societies' lists similarly include low-impact items."
The authors called for "more numerous and more courageous lists" to be developed, and they also asked the ABIM to collaborate with payers, who could help with services from the cost side.
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2 Steps to Advance Goals of Choosing Wisely Campaign