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Physicians Wade Into Efforts To Curb Unnecessary Medical Treatments

Groups suggest one third of health care spending is for unnecessary treatments; Dr. Donald Berwick, the former head of Medicare, called the campaign "a game changer." Video below news report...

By Julie Appleby, KHN Staff Writer

April 4, 2012 - Nine prominent physician groups today released lists of 45 common tests and treatments they say are often unnecessary and may even harm patients. The move represents a high-profile effort by physicians to help reduce the extraordinary amount of unnecessary treatment, said to account for as much as a third of the $2.6 trillion Americans spend on health care each year.

Each of the societies, representing both primary care doctors and specialists, picked five procedures that medical evidence shows have little or no value for certain conditions, and which they say should be questioned by patients and their doctors.

The list includes such common practices as routine electrocardiograms for patients at low risk for heart disease, and antibiotics for mild sinus infections. It is meant as a set of guidelines.


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Dr. Donald Berwick, the former head of Medicare and a longtime quality researcher, called the campaign "a game changer." Part of the reason is that patients generally trust doctors more than insurers, employers or others who attempt to influence what gets covered and what doesn’t.

"This could be a turning point if it's approached with energy," Berwick says. "Here you have scientifically grounded guidance from a number of major specialty societies addressing a very important problem, which is the overuse of ineffective care."

For the most part, the list is non-controversial, avoiding such hot-button issues as prostate-specific antigen testing for prostate cancer, or how often to perform mammography screenings for breast cancer.

But the items on the list include a broad range of interventions that can be revenue-generating for doctors, clinics and hospitals -- and costly for insurers and patients. Some also pose health risks to patients, because they may lead to additional radiation exposure, side effects from medications or unneeded surgeries.

"We need to use this opportunity to raise awareness that sometimes overtreatment or testing can be harmful," says Glen Stream, president of the American Academy of Family Physicians, one of the nine specialty groups participating.

The campaign comes amid a variety of efforts – some called for in the federal health law – to compare the effectiveness of treatments and to change payment incentives to doctors and hospitals to reward quality and penalize inefficiency

But efforts to slow medical spending growth often become political, spurring fears of rationing or "death panels."

"Anytime you are recommending against a test or treatment, people wonder 'is it for some economic interest?'" notes Stream, who says the evidence-based recommendations are designed to counter those concerns.

Among the items the groups recommend doctors and patients question: X-rays or other scans for uncomplicated headaches or early evaluation of low back pain, exercise electrocardiograms, often called "stress tests" or "treadmill tests" for low-risk patients with no symptoms of heart disease, and chemotherapy for patients with advanced solid-tumor cancers who are unlikely to benefit.

Some of the recommendations go against financial self-interest of the societies or their members because they are likely to result in fewer tests or procedures, Berwick notes. Because of that, some policy experts question whether physician groups will tackle the problem enthusiastically.

A 2011 study in the British Medical Journal, for example, found financial conflicts of interest among many of the doctors charged with drawing up clinical guidelines for diabetes and cholesterol treatments in the U.S. and Canada.

Nonetheless, physicians are becoming more involved in efforts to spread the message that more care is not always better. Other recent efforts to identify medically unnecessary treatments include 37 listed by the American College of Physicians in the Annals of Internal Medicine in January.

And in 2008, the National Priorities Partnership – a collaboration of 28 national health care organizations released its own analysis of overused services, including Caesarean-section deliveries and chemotherapy given to patients in the last two weeks of their lives.

The new campaign, called "Choosing Wisely," is funded by the ABIM Foundation, an arm of the American Board of Internal Medicine. The recommendations will be featured on the website of Consumer Reports magazine, which partnered with the foundation.

Some of this information is reprinted from with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

Educational materials will be distributed to physicians. The specialty societies in the campaign include those representing family physicians, cancer doctors, cardiologists, radiologists, gastroenterologists, allergists and kidney specialists. Another eight specialty groups – representing rheumatologists, pathologists, head and neck surgeons and others – are expected to release their own lists in the fall.

While calling the campaign "magnificent and long overdue," another quality expert noted that most physicians are already aware that most listed procedures are overused.

"This is important, but obviously a first step ... classic low-hanging fruit," says Steve Pearson, president of the Institute for Clinical and Economic Review, which evaluates medical treatments and is affiliated with Harvard Medical School.

He adds that many would find it remarkable that “it’s still required to tell physicians not to do these things.”

>> All 45 recommendations in a pdf booklet

>> Choosing Wisely web page on Consumer Reports web site

>> lists of 45 common tests and treatments

>> a third of the $2.6 trillion Americans spend on health care each year

>> About writer Julie Appleby

Consumers Report Published this today

Choosing Wisely: How to avoid unnecessary tests and treatments

Think you need an EKG as part of your annual exam? Think again. How about an MRI or CT scan for your headache? Probably not. And antibiotics for that case of sinusitis that has been bugging you? Sorry, that’s strike three.

Many common tests and treatments are often overused, both because patients too often ask for them, and because doctors are all too willing to order them.

More than a third of the primary-care doctors in a Consumer Reports survey, for example, said that their patients very frequently or quite often asked for unnecessary or duplicative medical tests. And two-thirds of the doctors said they had agreed to at least one such request. Other research suggests that up to a third of all medical care delivered in the U.S. may be unnecessary.

All that needless care can be harmful to your health—and your wallet. Unnecessary CT scans and X-rays, for example, expose you to potentially cancer-causing radiation. And any money spent on tests you don't need is money down the drain.

To help combat the problem, nine medical societies that together represent nearly 375,000 physicians across the country have banded together to come up with a list of 45 tests and treatments that they say are often overused.

And as part of that effort, Consumer Reports and the medical societies are developing summaries for patients about when those tests and treatments are needed—and when they aren't. Download PDFs of the reports produced so far:

When do you need an EKG or stress test for heart disease? - The American Academy of Family Physicians

When do you need an imaging test for a headache? - The American College of Radiology

When do you need antibiotics for sinusitis? - The American Academy of Asthma, Allergy, and Immunology

In the coming months, we will be working with the medical societies to produce additional reports, in English and Spanish, and collaborating with other consumer organizations to distribute them to diverse populations.

In the meantime, you can see summarizes of the Choosing Wisely lists on the website of the ABIM Foundation, the organization spearheading the effort.

These nine medical societies are participating in the effort:

American Academy of Allergy, Asthma & Immunolgy

American Academy of Family Physicians

American College of Cardiology

American College of Physicians

American College of Radiology

American Gastroenterological Association

American Society of Clinical Oncology

American Society of Nephrology

American Society of Nuclear Cardiology

Finally, to learn more about the project and get involved, go to

>> The information above is from this page at Consumer Reports


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