LOS ANGELES (May 1, 2017) -- Every day across the country doctors order tests and prescribe medications that may be unnecessary and potentially harmful. Inappropriate care wastes precious resources, drives up spending and diminishes the value of healthcare for patients.
The medical community is tackling this problem - with promising results.
Five of California's largest healthcare providers have decreased inappropriate or unnecessary care by adopting recommendations from the national Choosing Wisely initiative. Based on guidance from dozens of medical specialty societies such as the American College of Physicians, the effort has identified nearly 500 common medical tests and procedures that may not have clear benefit for patients and sometimes should be avoided.
The California providers highlighted their Choosing Wisely work and outcomes during a symposium Friday. The five are Cedars-Sinai, Los Angeles County + USC Medical Center, Sharp HealthCare in San Diego, Sutter Health in Northern California Sacramento and UCLA Health.
The Choosing Wisely approach, launched in 2012 by the American Board of Internal Medicine Foundation and Consumer Reports, gives doctors real-time information and sparks important conversations with patients about the appropriateness of certain diagnostic tests and treatments. As a result, patients waste less time undergoing testing that does not improve their care or taking medications that will not help.
Some providers, including Cedars-Sinai, have integrated Choosing Wisely recommendations into their electronic medical records systems. Alerts pop up on physicians' computer screens during patient visits, asking whether specific choices are necessary given a patient's medical condition and medications, and in light of recently published studies.
"After decades of discussion and debate, physicians, nurses and others responsible for delivering care at the bedside are demonstrating that we can address this problem of inappropriate care where the harms exceed the benefits," said Scott Weingarten, MD, MPH, chief clinical transformation officer at Cedars-Sinai and one of the symposium's organizers. "By empowering patients and doctors, we can deliver higher quality care more efficiently, increasing the value of healthcare for those who need it most."
The need to address this problem has never been greater. The cost of healthcare in the U.S. is rising at an unsustainable rate, accounting for nearly 1 in 5 dollars of the U.S. economy. One estimate from the Journal of the American Medical Association estimates that about 7 percent - or $192 billion - of annual healthcare spending may result from unnecessary care.
At the Cedars-Sinai symposium, leaders from the five healthcare providers shared their experiences and results through Choosing Wisely. Here are some highlights:
- Integrated almost 100 recommendations into its electronic health record system 3 ½ years ago.
- Patients of physicians who followed all the alerts had fewer medical complications and left the hospital sooner.
- When doctors fully adhered to all the alerts, costs dropped by hundreds of dollars per patient encounter. The health system avoided $6 million in healthcare spending in the first full year of Choosing Wisely implementation.
Los Angeles County + USC Medical Center and UCLA Health:
- Implemented and evaluated a multidisciplinary quality improvement initiative at the Los Angeles County Department of Health Services to reduce low-value, preoperative care such as blood tests and electrocardiograms for cataract surgery patients. (Most people don't need such tests before low-risk surgery unless they have certain health conditions or illnesses.)
- Dramatically reduced preoperative testing, freed up staff and provided six additional months of good vision to patients by shortening the wait time for surgery.
Sharp Rees-Stealy Medical Group in San Diego:
- Distributed wallet cards to patients listing "5 Questions to Ask Your Doctor Before You Get Any Test, Treatment or Procedure."
- Engaged community skilled nursing homes with Choosing Wisely recommendations.
- Decreased opioid prescribing by 10 percent in one year. Reduced use of unnecessary cardiac stress testing by about 5 percent.
Sutter Health in Northern California*
- Addressed more than 130 of the Choosing Wisely recommendations
- Engaged more than 3,000 clinicians, supporting 1 million patients and saved $66 million since 2010 by eliminating avoidable tests and treatments.
- Decreased the ordering of repeating labs by 20 percent in three hospitals after six months--a rate that has been maintained for two years.
*Sutter Health achieved some of these results for efforts prior to adopting Choosing Wisely recommendations