Choosing Wisely campaign to reduce wasteful tests shows disappointing results

Additional interventions are going to be necessary if the Choosing Wisely campaign, aimed at reducing the prevalence of generally overused tests that can waste insurers' money, is going to be successful, according to a new study.

For the study, published recently in JAMA Internal Medicine, researchers affiliated with the health insurer Anthem examined claims data for members of its health plans over a two- to three-year span through 2013. They looked at whether seven tests or services that Choosing Wisely listed as usually unnecessary had changed as a result of the campaign's efforts and found the following: 

  • The use of two services did decline: Imaging tests ordered for uncomplicated headache and cardiac imaging without a history of cardiac conditions.
  • The use of two services increased: Nonsteroidal anti-inflammatory drugs (NSAIDs) prescriptions for members with hypertension, heart failure or chronic kidney disease; and human papillomavirus (HPV) testing in women younger than 30.
  • The use of three services remained the same: Antibiotic prescriptions for acute sinusitis; preoperative chest X-rays with unremarkable history and physical exam results; and imaging for lower back pain without red-flag conditions.

Given the results, study authors say new measures will be necessary to get physicians to implement Choosing Wisely recommendations in their practices, including data feedback, physician communication training, clinician scorecards, patient-focused strategies and financial incentives. In addition, "the continued evaluation of low-value services will allow payers to use validated lists to inform quality improvement programs, as well as coverage, payment and utilization management decisions," the authors write.

Ordering unnecessary tests is a widespread problem, according to an earlier survey from Choosing Wisely that found 75 percent of doctors think their colleagues order at least one unnecessary test or procedure a week. But getting physicians to change may not be easy, as doctors say the top reasons they order extra tests or procedures are because of malpractice concerns and the desire to be extra cautious.

To learn more:
- read the study (subscription may be required)

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