Wednesday, May 16, 2012

Testing on WIHI

May 17, 2012: Testing, Testing! Is This Procedure Necessary?
2:00 – 3:00 PM Eastern Time
Daniel B. Wolfson, Executive Vice President and COO, ABIM Foundation
Steven Pearson, MD, MSc, FRCP,
President, Institute for Clinical and Economic Review – Institute for Technology Assessment
Amanda Kost, MD,
Acting Assistant Professor, University of Washington Department of Family Medicine
Donald Goldmann, MD,
Senior Vice President, Institute for Healthcare Improvement
Karen Boudreau, MD, FAAFP,
Chief Medical Officer, Boston Medical Center, HealthNet Plan; Former Senior Vice President, Institute for Healthcare Improvement and Medical Director for IHI Continuum Portfolio
Of all the sources of excessive health care spending, none may be higher on the list than the habit of ordering lots of expensive tests and procedures. This appetite for the best of what high-tech medicine can offer – whether warranted or not – is a big factor behind estimates that up to a third of health care spending in the US is wasteful and unnecessary. But everyone also has a story of someone, maybe themselves, helped by a diagnostic procedure. There’s no question that one person’s unnecessary test is another person’s lifesaver. So, how do we get closer to more appropriate use? And is there a more active role that physicians can play?

The ABIM Foundation is betting there is a way to bring the ordering of tests and procedures into better balance AND that doctors are key to making this happen. This is the premise behind the ABIM Foundation’s new campaign, Choosing Wisely, and the focus of the May 17 WIHI. Nine medical societies are on board (with eight more joining in the fall), and they’ve each identified five procedures that tend to be overused and that should trigger discussions to ensure that they’re really needed and of value. The American Academy of Family Physicians, for example, has a list that begins with thinking twice before immediately ordering imaging for low back pain.

WIHI host Madge Kaplan has assembled a great group of experts: The ABIM Foundation’s Daniel Wolfson will explain the campaign. Karen Boudreau will help us think through the role of family practitioners, while Steven Pearson will contribute some of the latest and sharpest thinking about evidence-based medicine and comparative effectiveness. Amanda Kost got to put on her “choosing wisely” shoes a bit ahead of the game by being part of the National Physician Alliance’s Promoting Good Stewardship in Medicine project. She’ll provide some key frontline learning on best practices that can help wean doctors and patients alike from reaching for the most expensive solution, first. Finally, IHI’s Don Goldmann, will discuss how Choosing Wisely aligns with other national initiatives and why it’s crucial that the medical profession take a leading role with health care reform.

Whether or not you’re directly in the role of ordering tests or procedures, we invite you to consider that we all have a part in making health care more effective and affordable – in other words, of true value to patients. Bring your hard questions and bring a colleague to WIHI on May 17th. See you then.
To enroll, please click here.


Barry Carol said...

Paul –

At the same time, I keep reading that Americans see the doctor less often than patients in many other developed countries and they spend less time in hospitals as well. I suspect that the biggest savings potential within our healthcare system might be in steering necessary and appropriate toward the most cost-effective high quality providers. In Boston, for example, I wonder how much would be saved if virtually all of the care delivered within the Partners system were done by more cost-effective hospitals and doctors instead, or alternatively, if Partners’ contract reimbursement rates were brought into line with the rest of the market.

Diverting non-emergency care away from emergency rooms and a more sensible approach to end of life care could also produce significant savings without harming care quality. Taking medical dispute resolution out of the hands of juries in favor of special health courts could reduce defensive medicine. Finally, making actual contract reimbursement rates easily ascertainable by both patients and referring doctors could allow healthcare to finally function like a real marketplace except for care that needs to be delivered under emergency conditions. If we did all that, we could more easily afford to overuse imaging and other testing if that’s what patients want.

Anonymous said...


I believe I have read that pricing is at least one of the issues in American 'over-testing' - that the Japanese, for example, have more imaging tests but the Japanese government controls pricing.
The bottom line is that at least one of the variables, whichever one it is, has to be controlled. Right now we are in control of nothing, and have the results to show for it.

nonlocal MD

Barry Carol said...

Nonlocal –

My understanding is that the Japanese developed imaging equipment that is not quite as good as ours but is one-tenth the cost. The Japanese, both providers and patients, view their equipment as acceptable whereas we probably would not, in part because of our litigation system. I believe it was T. R. Reid who discussed this in his book “The Healing of America.”

Within the U.S., imaging at free standing non-hospital owned clinics is far cheaper that at hospital owned facilities whether freestanding or not. To give one specific example, a friend of my wife needs to get a brain MRI once a year. She lives in Ohio. At Ohio State Medical Center, her regional center of excellence, they charge close to $4,000 per MRI. At her local community hospital, it’s $2,300. At a nearby freestanding non-hospital owned imaging center, the charge is $600. As it happens, I had the same test at the end of 2009 at a non-hospital owned imaging center in NYC. The insurer’s contract reimbursement rate: $475! The list price was $1,800. This is why we need price (and quality) transparency.