Conversation starter: Colorado physicians encourage wise health care decisions

Sunday, September 01, 2013 12:28 PM

Gina Claxton, CMS contributing writer

Physicians have the power to ensure that Coloradans receive the very best care possible. As health care experts, patients rely on you to help make good care decisions. Sometimes those decisions are straightforward. Sometimes they are much more complicated and can lead to medically unnecessary tests and procedures. Sometimes this medically unnecessary care puts patients in harm’s way, and it certainly drives inefficiency. In fact, the Institute of Medicine has found that 30% 
of health care is unwarranted or duplicative.

Having candid conversations about evidence-based best practices can improve care and enhance physician-patient relationships. “That’s why the Colorado Medical Society (CMS) has launched the statewide Choosing Wisely Colorado campaign to help us strengthen the bonds we have with our patients and at the same time ensure that they are getting the right care–no less and no more,” said CMS president-elect John Bender, MD.

Physician leadership
Colorado physicians regularly step up to important leadership responsibilities and so it wasn’t too surprising in the fall of 2012 that CMS became the first state medical society to endorse the national Choosing Wisely campaign aimed at encouraging conversations between patients and physicians and promoting evidence-based care decision making.

More proof that Colorado is unique recently surfaced through a CMS physician survey. Survey results (see figure 1) show that as compared to some national data Colorado physicians are taking keen interest in and responsibility for reducing medically unnecessary care. A July 2013 edition of JAMA featured results of a national physician poll that shows that only 36% of the 2,556 physician respondents thought they had a “major responsibility for reducing health care costs.”

The article has received a great deal of media attention by spinning an it’s-not-my-fault physician perspective and pinning the responsibility of escalating health care cost on trial lawyers, health insurance companies, hospitals and health systems, pharmaceutical and device manufacturers, and patients. Contrast those results with Colorado physician views that show that a strong majority (63%) believe that they “have a major responsibility to take the lead in Choosing Wisely conversations.” These conversations serve as the physician-operated vehicles to improve quality and drive down the cost of health care.

Other encouraging results indicate that overriding majorities of Colorado physicians (85%) believe that having conversations to educate patients about efficient use of health resources is “very important,” and almost all (92%) think it is very important for physicians to be aware of evidence-based recommendations for tests and procedures that display overuse, minimal benefit or potential harm. These results demonstrate that Colorado physicians are ready to take on the challenging task of reducing medically unnecessary care, and Choosing Wisely Colorado from CMS is here to help.

Saying no and doing the right thing
As Colorado physicians show their readiness to the lead in this effort, it is important to highlight tools that are available for your use. Let’s face it. Saying no can be hard, but when it comes to health care doing the right thing shouldn’t be.

Support for physician-patient conversations promoting optimal health care decisions was first initiated on a national level by the American Board of Internal Medicine Foundation (ABIMF) with the Choosing Wisely campaign. ABIMF has partnered with Consumer Reports and several specialty societies to produce lists of “Five Things Physicians and Patients Should Question.” These lists help physicians focus their efforts and provide a starting point for dialogue. The end goal of these discussions is to promote health care decisions that are supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. Choosing Wisely has a wide range of resources created with the support of dozens of specialty societies and physicians that can be found at www.choosingwisely.org.

Choosing Wisely Colorado puts a twist on the national campaign and is designed to support you. We have partnered with the Colorado Permanente Medical Group and a number of state specialty societies to concentrate on a subset of tests and procedures from the national list.

Choosing Wisely Colorado concentrates on the physician side of these conversations by sharing tips, tricks and tools used by some of Colorado’s best physicians that are exceptionally gifted at having these often challenging conversations. Visit the Choosing Wisely Colorado website to see the list of tests and procedures we are targeting.

Sometimes it’s not just what you say, but how you say it. We urge you to use the Colorado-physician-developed and vetted tools to help with these important patient conversations. Think about using the simple scripts from CMS the next time you and your patient are trying to choose wisely! Find our physician toolbox at www.cms.org/choosing-wisely.

Sources: Tilburt, Jon C. et al. Views of US Physicians about Controlling Health Care, JAMA, July 24/31, 2013, Vol 310, No. 4.
Colorado Medical Society Physician Member Poll, Choosing Wisely Colorado, June 2013.