Executive office update: Choosing Wisely

Sunday, September 01, 2013 12:07 PM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

In conjunction with the Colorado Permanente Medical Group and support from several state specialty societies, the Colorado Medical Society soon will launch our own homegrown version of the national “Choosing Wisely” campaign.

Choosing Wisely is a patient outreach effort to reduce the frequency of marginal or unnecessary diagnostics and procedures. The national campaign was developed by nine national medical organizations, each coming up with its own respective lists of services that are prone to overuse. Participation continues to grow, and now more than 50 specialty societies have joined the campaign. Recent polling of our physician members shows overwhelming support for this movement.

This same polling tells us this campaign is a formalization of common, everyday interactions with your patients while guiding them toward optimal care decisions by engaging them on the practical, economic and clinical aspects of their treatment regimen.

The survey found:

• Near universal belief among CMS members that it is “very important” physicians are aware of “specific, evidence-based recommendations for tests and procedures that display overuse, minimal benefit or potential for harm,” with 92% saying this is “very important” and 8% saying it is “somewhat” important.
• Overwhelming agreement that physicians should have conversations with patients “about efficient use of health resources, including potentially discouraging them from tests and procedures that display overuse, minimal benefit or potential for harm,” with 85% saying this is “very important” and 15% saying this is “somewhat important.”
• CMS members already engaging their patients in efforts to discourage inefficient use of health care resources, with 34% saying they have conversations “discouraging medically unnecessary tests and procedures” on a “daily” basis, another 34% saying they have such conversations “a few times a week,” and 17% saying “a few times a month.” Only 8% say they have these conversations “rarely” and 6% responded, “does not apply to my specialty.”

Colorado now has an evolving all-payer claims database and an abundance of peer-reviewed literature documenting patterns of over-utilization, technology reversals, and medical errors. At the same time, the rise of readily accessible, digitalized health care data and the scrutiny currently being enjoyed by hospitals and other facilities leaves physicians sitting in the wide-open cyberspace for all to see and scrutinize.

As clinical standards and a corollary of comparative effectiveness evolve, they can go stale or be replaced on a relatively short cycle, once or even twice a decade. The Choosing Wisely movement is critical to physician-to-physician and physician-to-patient communications and care management over time. Physicians and patients will make hundreds of iterative choices only to determine at some later point that the conventional wisdom has been supplanted by new clinical evidence, which in itself will bear close scrutiny. Engaging patients in what works and what might not – or what works at twice the price – is the essence of shared decision making and helping patients “Choose Wisely.”