Overuse of Services?
Rahul K. Shah, MD, George Washington University School of Medicine, Children’s National Medical Center, Washington, DC There were significant advances last year with attempts to rein in what many perceive to be overuse of medical and surgical services, technology, and procedures. This was not a new initiative, as many stakeholders have been attempting to do this for decades. However, times have changed. The impetus and the drivers now are physicians and physician groups. This is most likely an extension of overall increasing physician engagement in patient safety and quality improvement vis-à-vis transparency and public reporting. Hospitals and physicians have come to realize that the data is going to be available to the public, and as such, the healthcare professionals are in the best position to report and interpret this data. Indeed, the American Board of Internal Medicine’s Foundation has initiated a campaign called Choosing Wisely.1 This effort seeks to ensure that all stakeholders critically look at the services they order and recommend for patients and assess the data, the need for these services, and the resulting benefit. I implore you to spend 15 minutes reading the links below about this campaign as it has received a tremendous amount of press coverage and support from all pertinent stakeholders. Per the press release from the Choosing Wisely campaign, they define this initiative explicitly and it is worth reiterating their wording that the intent is for the specialties to target “specific tests or procedures that are commonly used, but not always necessary in their respective fields.” 2 Overall, in the first phase of this campaign, there were 45 tests and procedures identified by the nine participating specialties. The initial nine specialties participating in the Choosing Wisely campaign are the American Academy of Allergy, Asthma & Immunology; 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; and the American Society of Nuclear Cardiology. The initiative, from a consumer viewpoint, is appealing. However, as a healthcare provider, it is difficult to look introspectively at our practices and question what we are doing and potentially overusing. Nevertheless, it is a great initiative because it actually empowers the physicians to look at their own practices. The onus is on us to look at our practice trends or we all know that others will do this for us. In this regard, our Academy has partnered with the Choosing Wisely campaign for the second phase to look at our practices to see if such a test or procedures can be identified. Interestingly, and to the credit of our Academy leadership and membership, we were the first surgical society to have partnered with this campaign. It is helpful to know what other societies have identified as overuse measures. The Consumer Reports brand has assisted the Choosing Wisely campaign to produce a patient-friendly version of the 45 overuse tests or procedures.3 These include such questions as: When do you need an EKG/stress test for heart disease (family physicians)? When do you need imaging for a headache (radiologists)? When do you need antibiotics for sinusitis (asthma/allergists/immunologists and family physicians)?2 I leave the reader of this column to interpret and read more about these ideas put forth by the respective specialties. The goal of this Bulletin column is to raise Academy members’ awareness that there are large forces including healthcare professionals taking a critical look at the overuse of tests/procedures. We have been given an opportunity as physicians to do this with our own specialty and the onus rests with us to ensure that we continue to advocate for the best interests of our patients and ensure they receive the care that they need from our specialists. We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice. References http://choosingwisely.org/?page_id=13, accessed April 13, 2012. http://choosingwisely.org/wp-content/uploads/2012/03/033012_Choosing-Wisely-National-Press-Rls-FINAL.pdf, accessed April 13, 2012. http://consumerhealthchoices.org/campaigns/choosing-wisely/, accessed April 13, 2012.
Rahul K. Shah, MD, George Washington University School of Medicine, Children’s National Medical Center, Washington, DC
There were significant advances last year with attempts to rein in what many perceive to be overuse of medical and surgical services, technology, and procedures. This was not a new initiative, as many stakeholders have been attempting to do this for decades. However, times have changed. The impetus and the drivers now are physicians and physician groups. This is most likely an extension of overall increasing physician engagement in patient safety and quality improvement vis-à-vis transparency and public reporting. Hospitals and physicians have come to realize that the data is going to be available to the public, and as such, the healthcare professionals are in the best position to report and interpret this data.
Indeed, the American Board of Internal Medicine’s Foundation has initiated a campaign called Choosing Wisely.1 This effort seeks to ensure that all stakeholders critically look at the services they order and recommend for patients and assess the data, the need for these services, and the resulting benefit. I implore you to spend 15 minutes reading the links below about this campaign as it has received a tremendous amount of press coverage and support from all pertinent stakeholders.
Per the press release from the Choosing Wisely campaign, they define this initiative explicitly and it is worth reiterating their wording that the intent is for the specialties to target “specific tests or procedures that are commonly used, but not always necessary in their respective fields.” 2
Overall, in the first phase of this campaign, there were 45 tests and procedures identified by the nine participating specialties. The initial nine specialties participating in the Choosing Wisely campaign are the American Academy of Allergy, Asthma & Immunology; 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; and the American Society of Nuclear Cardiology.
The initiative, from a consumer viewpoint, is appealing. However, as a healthcare provider, it is difficult to look introspectively at our practices and question what we are doing and potentially overusing. Nevertheless, it is a great initiative because it actually empowers the physicians to look at their own practices. The onus is on us to look at our practice trends or we all know that others will do this for us. In this regard, our Academy has partnered with the Choosing Wisely campaign for the second phase to look at our practices to see if such a test or procedures can be identified. Interestingly, and to the credit of our Academy leadership and membership, we were the first surgical society to have partnered with this campaign.
It is helpful to know what other societies have identified as overuse measures. The Consumer Reports brand has assisted the Choosing Wisely campaign to produce a patient-friendly version of the 45 overuse tests or procedures.3 These include such questions as: When do you need an EKG/stress test for heart disease (family physicians)? When do you need imaging for a headache (radiologists)? When do you need antibiotics for sinusitis (asthma/allergists/immunologists and family physicians)?2 I leave the reader of this column to interpret and read more about these ideas put forth by the respective specialties.
The goal of this Bulletin column is to raise Academy members’ awareness that there are large forces including healthcare professionals taking a critical look at the overuse of tests/procedures. We have been given an opportunity as physicians to do this with our own specialty and the onus rests with us to ensure that we continue to advocate for the best interests of our patients and ensure they receive the care that they need from our specialists.
We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
References
- http://choosingwisely.org/?page_id=13, accessed April 13, 2012.
- http://choosingwisely.org/wp-content/uploads/2012/03/033012_Choosing-Wisely-National-Press-Rls-FINAL.pdf, accessed April 13, 2012.
- http://consumerhealthchoices.org/campaigns/choosing-wisely/, accessed April 13, 2012.