Little Threat to Specialists' Revenue in Choosing Wisely Recommendations

Cheryl Clark, January 27, 2014

Treatment guidance from medical specialty groups varies widely in terms of its potential financial impact on providers, acknowledges the head of the American Board of Internal Medicine Foundation, which backs the Choosing Wisely initiative to promote evidence-based care.

Most of the 60 physician societies and medical specialty groups participating in the American Board of Internal Medicine Foundation's Choosing Wisely campaign to curb unnecessary tests or treatments do not list high-revenue services, according to the New England Journal of Medicine.

The paper, entitled "Choosing Wisely–The Politics and Economics of Labeling Low-Value Services," is the first to criticize the lists generated by the campaign, an increasingly well-publicized effort to "promote conversations between physicians and patients" and reduce unnecessary or non-evidence-based care that may do more harm than good.

"We are not critical of the campaign. We applaud the campaign," says Nancy E. Morden, MD, lead author and associate with the Dartmouth Institute for Health Policy & Clinical Practice who worked with researchers at Harvard Medical School. "But there's no value in generating lists of things we [doctors] almost never do, and no value in generating lists of things that cost pennies. We need to get at more meaningful identification of services that really impact spending."

"We know that there are a lot of high-volume, high-cost services with low value that are still provided, so we hope this will evolve into bolder lists that really consider the bread and butter services of some of these specialties, services that may not represent true value in healthcare." It is, she says, no more than "giving lip service to stewardship."

For example, Morden says, The American Academy of Otolaryngology ?Head and Neck Surgery Foundation, lists three imaging tests and two uses of antibiotics that the academy suggests physicians and patients should avoid or think seriously about before undergoing.

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