ABIM Foundation announces the Choosing Wisely campaign

PHILADELPHIA, PA–Recognizing that patients often ask for tests and treatments that are not necessarily in their best interest, and physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases, the ABIM Foundation has joined with nine leading medical specialty societies to develop evidence-based lists of tests and procedures for patients and physicians to question as part of Choosing Wisely™. The goal of this campaign is to help physicians, patients and other health care stakeholders think and talk about overuse or misuse of health care resources in the United States.

Consumer Reports, the nation’s leading expert, independent, nonprofit consumer organization, has also joined the campaign to provide resources for consumers and physicians to engage in these important conversations.

The campaign is part of the ABIM Foundation’s goal of promoting wise choices by clinicians in order to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions and reduce the rapidly-expanding costs of the health care system. The lists ofFive Things Physicians and Patients Should Question is modeled after the successful National Physicians Alliance (NPA) project titled “Five Things You Can Do in Your Practice,” which was funded by the ABIM Foundation in 2009.

As part of Choosing Wisely, each participating specialty society will identify its own list of five common tests or procedures whose use in their profession should be discussed or questioned. The lists will be unveiled in April 2012. The societies were given the following parameters to develop the lists:

• Each item should be within the specialty’s purview and control;
• Procedures should be used frequently and/or carry a significant cost; and
• There needs to be evidence to support each recommendation.

“Physicians play a leading role in addressing problems with our nation’s health care system. That is why the ABIM Foundation is proud to be working with specialty societies that have proactively decided to address some of the most important issues in health care head on,” said Christine K. Cassel, MD, president and CEO of the ABIM Foundation. “By identifying specific procedures or tests that may commonly be ordered, but not always necessary to improving patient care, we’re kicking off an important and overdue conversation about making wise choices in health care. Everyone – providers, patients and others – plays a part in being better stewards of the system’s finite resources.”

Organizations participating in Choosing Wisely include:

• 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
• American Society of Nuclear Cardiology
• Consumer Reports

The Congressional Budget Office estimates that up to 30 percent of care delivered in America goes toward unnecessary tests, procedures, medical appointments, hospital stays and other services that may not improve people’s health – and in fact may actually cause harm. If current trends remain unchanged, the Centers for Medicare & Medicaid Services project U.S. health care spending will reach $4.3 trillion and account for 19.3 percent of the nation’s gross domestic product by 2019.

First announced in March 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. It is part of the ABIM Foundation’s long history of advancing medical professionalism and supporting similar initiatives. In 2002 the Foundation, along with the American College of Physicians Foundation and European Federation of Internal Medicine, authored Medical Professionalism in the New Millennium: A Physician Charter. The Physician Charter has as its fundamental principles the primacy of patient welfare, patient autonomy and social justice and articulates professional responsibilities of physicians, including a commitment to improving quality and access to care, advocating for a just and cost-effective distribution of finite resources and maintaining trust by managing conflicts of interest.

To learn more about Choosing Wisely visit www.ChoosingWisely.org.

Leaders of organizations participating in Choosing Wisely comment on the campaign:

• American Academy of Allergy Asthma & Immunology
  “The Choosing Wisely™ campaign will serve as an additional catalyst to assure that allergy, immunology and asthma testing and treatment strategies advance optimal patient care in a cost-effective manner,” according to Dennis K. Ledford, President of the American Academy of Allergy, Asthma & Immunology (AAAAI).
• American Academy of Family Physicians
  “For decades, family physicians have worked to ensure high-quality, cost-effective care for our patients,” said Glen R. Stream, MD, MBI, FAAFP, president of the American Academy of Family Physicians. “Our involvement in the Choosing Wisely™ campaign underscores this commitment. Maintaining ongoing relationships with our patients throughout their lifespan helps us provide the best care possible and significantly decreases the need to order tests and procedures. The comprehensive, integrated care provided through a patient-centered medical home (PCMH) significantly reduces duplication and eliminates unnecessary treatment. It also encourages an open dialogue between physicians and patients, which helps them ‘choose wisely’ when it comes to a treatment plan.”
• American College of Cardiology
  “With the medications, devices and imaging technology available to cardiologists today, we can save and improve the lives of patients who would not have had a chance just 15 years ago,” said American College of Cardiology President David Holmes, Jr., MD, FACC. “We have a responsibility to use these powerful tools effectively. We are pleased to join with our partners in the Choosing Wisely™ campaign to encourage open communication about the risks, costs and benefits of tests and treatments so that our patients can be informed partners in important decisions about their care.”
• American College of Physicians
  “The Choosing Wisely™ campaign complements existing efforts of the American College of Physicians to help internal medicine specialists and subspecialists provide the best possible care to their patients while reducing unnecessary health care costs,” said Virginia L. Hood, MBBS, MPH, FACP, president, American College of Physicians. “Many factors contribute to the overuse and misuse of diagnostic tests that do not improve health and can cause harm: a lack of guidelines for many clinical problems, long-standing doctor habits and patient expectations. ACP will continue to produce evidence-based recommendations and educate clinicians and patients about how to pursue care together that improves health, avoids harms and eliminates wasteful practices.”
• American College of Radiology
  “American College of Radiology (ACR) participation in Choosing Wisely™ is an extension of our numerous efforts to ensure appropriate, high-quality medical imaging care and radiation therapy for all who need it. We urge all physicians to use ACR Appropriateness Criteria to determine which imaging tests are best for a patient’s condition or when no imaging exam may be warranted at all. Patients should seek out ACR accredited facilities to be sure that physicians, equipment and personnel have met stringent standards. And we urge lawmakers and government agencies to work with providers to arrive at quality-and-safety based health policies that protect access to care,” said Harvey Neiman, MD, FACR, chief executive officer of the American College of Radiology.
• American Gastroenterological Association
  “The American Gastroenterological Association (AGA) is honored to be joining the ABIM Foundation and many other respected medical societies in the Choosing Wisely™ campaign,” said C. Richard Boland, MD, AGAF, president of the AGA Institute. “The AGA believes that patients should have access to the screening tests that will most benefit them in the treatment and diagnosis of their condition. However, we realize that steps need to be taken to ensure that patients and health care professionals understand how these tests should be used in order to minimize inappropriate use. Therefore, we are participating in this campaign to help educate patients and health care providers about the proper guidelines and quality measures to consider when making important health care decisions.”
• American Society of Clinical Oncology
  “The Choosing Wisely™ campaign will help patients and health care providers consider the value of care options, a crucial step in addressing escalating costs and ensuring that all Americans have access to high-quality care,” said Allen S. Lichter, MD, CEO, American Society of Clinical Oncology.
• American Society of Nephrology
  “ASN looks forward to working with the ABIM Foundation and other leading societies to improve care for patients through the Choosing Wisely™ campaign,” stated ASN president Ronald J. Falk, MD, FASN. “ASN’s unwavering dedication to this important effort reflects the society’s obligation to improve the lives of the nearly 30 million Americans with kidney disease,” he adds. “The campaign also reflects my personal commitment that ASN and its nearly 14,000 members provide high-quality, patient-centered care.”
• American Society of Nuclear Cardiology
  “Delivering high-quality, patient-centered care is the obligation of every medical professional,” said John J. Mahmarian, MD, president-elect of the American Society of Nuclear Cardiology. “TheChoosing Wisely™ campaign represents a unified effort in the medical community to promote best practices and good stewardship of health care resources by experts in the field. ASNC is proud to be a part of this initiative and share our professionals’ recommendations for optimizing the delivery of imaging services to patients in need.”
• Consumer Reports
  “Consumer Reports is excited to be able to reach millions of consumers with important health care information in its role as the ‘consumer communicator’ in the Choosing Wisely™ campaign,” said Jim Guest, president of Consumer Reports. “This is a valuable partnership that brings the ABIM Foundation, nine medical societies, and Consumer Reports together to help influence the health decision-making process and put new approaches immediately into practice. By effectively translating critical health care information and working with other consumer organizations to disseminate it, we strongly believe we can improve the marketplace.”

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