To Reduce Spending, American College of Physicians Will Advise Doctors What's Too Costly and Useless

Another example, he says, is the excessive ordering of magnetic resonance image tests for patients' joints before operations "when there's no need to get those done."

Weinberger was asked if the ACP is prepared for criticism from other providers, such as radiologists, who may perceive the guidelines as an effort to take business away from them, or perhaps insinuating themselves into areas where they have no expertise.

But Weinberger replies that's not the ACP's worry. "Our first responsibility is to patients and society, to provide the best possible care that keeps costs in line. We have no interest in cutting down those procedures or tests that should be done and done appropriately."

And, he added "there will still be plenty of business for the radiologists—plenty of appropriate diagnostic work that needs to be done."

Other areas that are ripe for the initiative's scrutiny include cardiology studies that include exercise testing, some of which include imaging studies. Also included will be numerous blood tests that are done routinely prior to surgical operations. "Some may be indicated, but some may not be," he says.

The use of certain drugs may be unnecessary, but are prescribed by doctors out of habit, he says. Take the tuberculosis drug Isoniazid. When patients are taking that medication, Weinberger says, their doctors usually order liver function tests routinely, "when they don't necessarily need to be done routinely in all patients."

The ACP also will be recommending numerous ways in which physicians communicate with their patients other than through an office visit, such as greater use of e-mail, "which may indicate you don't need to have the patient come in for an office visit after all." More physicians will be working with payment models that involve "the patient centered medical home," rather than relying on income from those patient visits.

How does he think physicians will take these recommendations, especially if they challenge or question decades' worth of practice? Weinberger says he feels confident they will understand and do the right thing once they see the evidence.

"I'm not sure there is going to be that much controversy," he says. "The physicians we've spoken to agree that there's a lot of overuse and misuse of care. And the overwhelming sentiment is that it really is the responsibility of physicians to address this and take control of this. It's a lot better if we do it than if the insurance industry does it, or any other third-party payer."