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The Medical Professionalism Blog

Choosing Wisely® Summit: Making Connections

On April 30, 21 diverse organizations will convene to present their findings and learn from each other about ways to advance the Choosing Wisely campaign at the local level. The ten regional health collaboratives and eleven specialty societies and state medical associations are sub-grantees of the Robert Wood Johnson Foundation (RWJF) and dedicated to improving the quality, patient experience and affordability of health care. They also share the commitment to use the framing of the Choosing Wisely campaign around waste and doing no harm to advance conversations between patients and physicians. They are connectors of organizations, patients, physicians and conversations around the Choosing Wisely campaign. They link the voice of the patient with the voice of the physician, setting this campaign apart from previous efforts: patient-physician partnership and physician leadership.

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In response to: Are docs Choosing Wisely?

On April 15th Jordan Rau of Kaiser Health News published a thoughtful article examining the Choosing Wisely campaign.

This type of analysis is a critical part of the transparent, honest dialogue about the issues of unnecessary medical care that we have sought to encourage since launching the campaign. That said, we think it is unfortunately shortsighted to measure the success of Choosing Wisely based on whether or not the physicians involved have cut their own income. Read more »

It’s About the Conversation

There is an interesting conversation taking place around Choosing Wisely® and a recent JAMA study by Pearson and Gliwa. It’s heartening to see that the campaign is doing what it was always meant to do – spark conversation.

In their study, Gliwa and Pearson sought to “evaluate the role that evidence on benefits, risks, and costs plays in selecting a service for the Top 5 lists.” They conclude “Specialty societies can enhance trust in the Choosing Wisely campaign by defining more clearly the types of potentially wasteful medical care they seek to eliminate, and by providing a clear evidentiary justification for the selection of each service.”

Tackling the concept of “waste” in health care is not an easy thing. There are many factors that contribute to waste – higher costs and unnecessary treatments being only a couple of them. In the end, the Choosing Wisely campaign originated out of the desire to provide a space for waste to be discussed—between physicians and their patients, groups of physicians and physicians and the organizations in which they work.

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Choosing Wisely® Utah Town Hall: Voices Reflect Gains in the Campaign

On March 27, HealthInsight Utah hosted a town hall on the campus of the University of Utah. HealthInsight Utah is a sub-grantee of a Robert Wood Johnson Foundation grant to the ABIM Foundation to increase awareness of the Choosing Wisely campaign at the local level. They are one of 21 grantees who are all pursuing tactics to initiate conversations about overuse.

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Choosing Wisely® Videos are Worth a Thousand Words

The essence of the Choosing Wisely campaign has been captured in four short yet inspiring videos that are now available on the Choosing Wisely website. The videos provide another vehicle to express the tenets of the Choosing Wisely campaign. In them, 18 leaders in health care—all with diverse roles—articulate ways in which the campaign remains rooted in physician professionalism and leadership, and the partnership between the patient and physician in deciding what care is most appropriate.

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Teaching Choosing Wisely® in Medical Education and Training: The Story of a Pioneer

Steve Weinberger, MD, Executive Vice President of the American College of Physicians (ACP), has called for stewardship of resources to be considered a seventh competency of Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) because of its importance to quality, safety and affordability. While the widespread participation in Choosing Wisely by specialty societies has called attention to the need for physicians to possess the necessary knowledge, skills and attitudes to be good stewards of health care resources, the question we heard from many educators after they are convinced stewardship is an essential competency is how do residents and students learn about these competencies – how do I teach it?

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Action on Antibiotic Overuse

Overuse of antibiotics represents a serious challenge facing the health care system. This week, a number of well-known organizations, inspired by the aims of the Choosing Wisely® campaign, came together to focus their efforts on this issue.

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Choosing Wisely® Abroad

I couldn’t be more pleased that the Choosing Wisely campaign is finding its way across international borders. Choosing Wisely Canada will be operational this fall under the umbrella of the Canadian Medical Association and guided by the University of Toronto. At least eight Canadian specialty societies will release lists of five tests and procedures to question and others are expected to follow. The Netherlands, Germany, United Kingdom, Denmark, Italy, New Zealand, Australia and Israel have all expressed interest in implementing the campaign. While the ABIM Foundation has not deliberately tried to advance Choosing Wisely to other countries, we are nonetheless supportive of these efforts and have provided guidance as they move forward with their own initiatives.

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Response to JAMA Internal Medicine Commentary

The Choosing Wisely campaign was recently criticized for lacking a solid methodological approach in an editorial in JAMA Internal Medicine by Deborah Grady, Rita Redberg and William Mallon. As such, we wanted to clarify the procedures that all of our specialty society partners have followed in creating their recommendations of tests and treatments that physicians and patients should question.

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The Necessity of Stewardship

This post was written by Dr. John Benson, Jr., President Emeritus, American Board of Internal Medicine and ABIM Foundation.

The prospect of health care consuming 20% of the GDP by 2020 is unconscionable so corrective actions have enormous urgency.  There are some initiatives underway that address this issue and still others that need to happen in order to bring stewardship to the forefront of individual physicians and organizations at-large.

Through its admirable Choosing Wisely® campaign, the ABIM Foundation has promulgated the concept of stewardship of limited resources—especially unnecessary, even harmful, costs—as a clinical competence to be stressed to trainees. None too soon, especially since only 36% of physicians polled in 2013 feel they are responsible for rising costs or their reduction. Obvious proof that there is so much more ground to cover in this area.

As a start:

  • Some teaching hospital administrators, who see Graduate Medical Education’s acolytes as a risk to their current modus operandi, must stop acting as competitors in a local technology arms race: pricing services without relationship to costs, skimping on nurse/inpatient ratios, counting outpatient clinics as losers and regarding premature readmissions as revenue.
  • ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC.
  • ACP could grade use of resources through MKSAP questions.
  • CMS, which has the ultimate negotiating position in the form of reimbursement for Medicare services, could only accept negotiated bundled charges. It could also refuse payment for non-compliance with the Choosing Wisely recommendations.
  • Educators, if forced to adhere to stricter ACGME’s accreditation standards, can reward suitable ordering behavior by trainees or require meaningful interventions.

The time is well past exhortation. The issue has been recognized for decades. Hard choices and penalties must go beyond training the next generation. 2020 is closing in.