Berwick: Zapping Overtreatment, Costs Takes 'Courage'

Cheryl Clark, for HealthLeaders Media , August 1, 2013

So the AHA is trying to slay its dragon from within. That's very cool.

I wanted to dig in deeper to each of these efforts to see where they began, how far they've come, and what they accomplish in coming years. Here's what I found:

Choosing Wisely Expanding

Daniel Wolfson, the ABIM Foundation's  executive vice president and COO, explains that the Choosing Wisely campaign began in 2001 with the simple premise that "physicians should be good stewards of resources."

With a small ABIM Foundation grant, the National Physician Alliance came up with five types of procedures or practices in primary care "for which the risks outweigh the benefits."

That was followed by a 2010 article in the New England Journal of Medicine. by Howard Brody, MD, director of the Institute for the Medical Humanities at the University of Texas. Against a backdrop of Congressional wailing about the out-of-control spiral of healthcare costs, author Brody suggested that physicians couldn't pretend to be blameless bystanders helplessly watching the system explode.

Rather, the enormous variation in healthcare costs across the country was evidence that physicians, the ones ordering tests, drugs, and procedures, were failing to conform to evidence when they urged some expensive and sometimes harmful for their patients. Doctors needed to clean their own house.

Brody suggested that every physician specialty group develop a "blue ribbon committee" to agree on "five diagnostic tests or treatments" commonly ordered by that specialty that are among the most expensive, and which had not been shown to not provide meaningful benefit to major categories of patients.

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