Doing even more about 'less is more'

One of the mantras of modern healthcare--and by extension, modern medical imaging--has been "less is more." There is a consensus among participants in our healthcare system that doing away with low-value medical tests that provide few, if any, benefits, yet contain risks, is a worthy endeavor.

Yet, how do we determine which of these tests and procedures are of such low value? To start dealing with that question, the American Board of Internal Medicine launched the Choosing Wisely campaign in 2012 with the idea of getting various medical societies (like the American College of Radiology) to contribute their lists of medical tests they believe are being overused.

And while many of these societies are participating in the Choosing Wisely campaign, there have been concerns, as described in a study published in JAMA Internal Medicine in April, claiming that the Choosing Wisely lists haven't been selected as carefully as they should have been.

In that study, the authors came up with their own list of low-value medical exams (most of which involved medical imaging) by first assembling a technical expert panel and then going through a four-step process to develop a top-five list. The process was transparent, contained clear criteria for inclusion on the list and included input from frontline medical personnel.

Now, another study, also published in JAMA Internal Medicine is tackling the issue. In this study researchers identified 26 low-value medical procedures--many of which are radiology- or imaging-related--that are costing Medicare at least $1.9 billion and could cost up to $8.5 billion depending on the sensitivity and specificity of the study model used.

As Mitchell Katz, M.D., and colleagues point out in an accompanying editor's note, the study "highlights the opportunity for eliminating unnecessary care."

It seems the more we can highlight the need to reduce these low-value tests, the better. After all, we have seen evidence that, despite recommendations from medical organizations about the efficacy of certain tests, they still end up being used in increasing numbers.

For example, yet another study, published last fall in JAMA Internal Medicine, pointed out that in the decade leading up to 2010, the proportion of patients being treated for back pain who ended up undergoing CT or MRI scans increased from 7.2 percent to 11.3 percent, despite numerous published clinical guidelines that recommended more a conservative approach.

Studies like the most recent JAMA Internal Medicine piece, provide other researchers the opportunity to take that work, improve the methods used by authors and develop even better methods for measuring--and reducing--unnecessary care. - Mike (@FierceHealthIT)

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