Just Say No: Concrete Steps to Cut Healthcare Spending

Last year, the American Board of Internal Medicine Foundation and Consumer Reports teamed up to launch the “Choosing Wisely” campaign. Each of the 39 medical specialty societies has, within its arena, identified five specific medical screening or treatment procedures which are probably unnecessary under particular circumstances, but might be recommended by a physician eager to minimize personal liability and/or make more money from each patient.

The project also includes a set of articles on common medical situations or decision points which can help employees choose the right path.

Promoting Conversation

The purpose of Choosing Wisely is “to promote conversations between patients and physicians about tests which may be ineffective, unnecessary or needlessly risky,” according to a Consumer Reports website enumerating “Consumer Health Choices.”

The physicians behind the effort are just as concerned about unnecessary procedures and tests as those who pay for them. One reason is many procedures and tests carry medical risks which may not be worth the benefit of the diagnostic screening or medical procedure in question. Also, most patients themselves, whether they have financial skin in the game (as most do) or not, are not hypochondriacs with an unlimited appetite for visits to the doctor.

The only apparent tie-in to the Affordable Care Act (ACA) is that employers offering health benefits obliged to expand the scope of medical services to satisfy “minimum essential benefits” standards (including preventive medicine) may experience a surge in employee utilization of services, some necessary, others not.

Here are examples of advice which came out of the Choosing Wisely campaign, with regard to some common tests and procedures from various medical specialty organizations. Each statement below can be found on this webpage along with an explanation, plus research citations to support the findings.

American Academy of Family Physicians:

  • Don’t do imaging for low back pain within the first six weeks, unless red flags are present.
  • Don’t order EKGs or any other cardiac screening for low-risk patients without symptoms.
  • Don’t screen women younger than 30 for cervical cancer with HPV testing, alone or in combination with cytology.
  • Don’t screen for carotid artery stenosis in asymptomatic adult patients.

American Academy of Pediatrics:

  • Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
  • Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
  • CT scans are not necessary in the routine evaluation of abdominal pain or the immediate evaluation of minor head injuries.

American College of Obstetricians and Gynecologists

  • Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.
  • Don’t perform routine annual Pap tests in women 30-65 years of age.
  • Don’t screen for ovarian cancer in asymptomatic women at average risk.

American College of Cardiology

  • Don’t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.
  • Don’t perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.
  • Don’t perform echocardiography as routine follow-up for mild, asymptomatic native valve disease with no change in signs or symptoms.

American Academy of Neurology:

  • Don’t perform electroencephalography (EEG) for headaches.
  • Don’t use opioid or butalbital treatment for migraine except as a last resort.
  • Don’t perform imaging of the carotid arteries for simple syncope without neurologic symptoms.

American Academy of Ophthalmology

  • Don’t perform preoperative medical tests for eye surgery unless there are specific medical indications.
  • Don’t routinely order imaging tests for patients without symptoms or signs of significant eye disease.
  • Don’t order antibiotics for adenoviral conjunctivitis (a variety of “pink eye” caused by a particular virus).

As noted, the site also features consumer-friendly articles on such topics as:

  • Allergy tests: When you need them and when you don’t
  • Cancer care at the end of life: When to choose supportive care
  • EKGs and exercise stress tests: When you need them
  • Treating heartburn and gastro esophageal reflux disease

The Consumer Reports “Consumer Health Choices” website contains sets of free articles on tests and treatments, drugs and supplements, doctors, hospitals and even a set of prices (including a national range as well as national and local “fair” prices) for procedures ranging from brain MRIs to vasectomies as well as cosmetic procedures, such as breast augmentation/reduction.

As the old saying goes, you can lead a horse to water, but you can’t make it drink. Fortunately, employees are not horses. Leading them to independent information on medical and health topics will cause at least some of them to think twice about blindly following their doctors’ instructions, or taking matters entirely into their own hands with possible disastrous results.


© Copyright 2013. All rights reserved.
Brought to you by: Gordon Advisors, P.C.


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