Wednesday, April 4, 2012

Medical Societies Identify Unnecessary Tests and Procedures

Today’s Managing Health Care Cost Indicator is 45

The American Board of Internal Medicine Foundation published its compendium of five tests that each of nine specialty societies have agreed don’t usually offer any value to patients, and that we should not routinely order.  Each list can be accessed at this link.

I’ve mentioned the oncologist and internal medicine recommendations in past posts.  Some of my colleagues feel that the recommendations are not enough – but I think they’re a GREAT first step.  Once we have agreement about what tests and procedures aren’t worth doing, we can start measuring how often we’re doing them.  We can improve what we measure – and it’s terribly hard to decrease variation and decrease waste when we can’t measure it because we don’t agree about definitions.

There are things missing in this set of unnecessary tests.  For instance the otolaryngologists didn’t finger the inappropriate and highly remunerative upper respiratory endoscopies. Still, most of us know some gastroenterologists who recommend followup colonoscopies at too short an  interval – and having the American Gastroenterologic Association explicitly say that this is inappropriate can save money, can save time, and can save potential iatrogenic harm.

Social norms are important, and the ABIM Foundation has made it tough for specialty societies NOT to participate.  Eight more specialty societies will come up with their “top five” list of tests and procedures that physicians and patients should question this fall.

Public transparency is also important, and the ABIM Foundation is collaborating with a group of consumer organizations including Consumer Union (publisher of Consumer Reports) to let our patients know about these recommendations.  It’s nice to see providers taking on the critical issue of overutilization of tests and procedures with little or no incremental value.

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