Cash cow procedures left off Choosing Wisely list

When joint surgeons listed unnecessary procedures done by their specialty, none of their choices included high-dollar surgeries commonly performed despite lack of evidence for their use. Instead, doctors "chose stuff of no material consequence that nobody really does," The Washington Post reported.

Surgeons cited procedures including saline injections to treat knee pain, for which Nancy Morden, M.D., a researcher at Dartmouth Institute for Health Policy and Clinical Practice, found zero Medicare claims in 2011. "That's how pathetic that item is," she told the Post.

Through the Choosing Wisely initiative, 54 specialty societies have flagged overused procedures that benefit neither patients nor the healthcare system. Where these lists have been adopted, utilization of wasteful services fell, the Post reported. Cedars-Sinai Health System in Los Angeles, for instance, saw decreased use of benzodiazepines to treat the elderly after implementing a recommendation by the American Geriatrics Society. The recommendation was based on evidence that elder use of these drugs resulted in more falls.

But 'choosing wisely' is not just hard for patients, it is also hard for physicians, according to David Asch, executive director of the Penn Medical Center for Innovation. Some of the largest medical associations list services performed by other specialists. "They were willing to throw someone else's services into the arena, but not their own," Morden told the Post.

Besides this fly in the ointment, results of an April study from the National Institutes of Health recommend further fine tuning the Choosing Wisely program. Researchers evaluated how evidence related to benefits, risks and costs affects the selection of least beneficial procedures.

"As Choosing Wisely continues to grow, clarity on the evidentiary justifications for the lists will be will be crucial for the overall credibility of the campaign," the study states, according to a research announcement. "Specialty societies can enhance trust in the Choosing Wisely campaign by defining more clearly the types of potentially wasteful medical care they seek to eliminate, and by providing a clear evidentiary justification for the selection of each service."

For more:
- here's the Washington Post article
- see the research announcement
- read the JAMA research letter (subscription required)