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Taking Action to Reduce Overuse

By Kimberly Mitchell | Thursday, September 17, 2015

For one week in October, clinicians across the US will be taking action to reduce overuse in health care. In this post, Shannon Brownlee, Senior Vice President of the Lown Institute, describes RightCare Action Week (October 18-24, 2015), an effort to take a visible stand in support of a better health care system. Brownlee is also a featured guest on the October 1 WIHI that will highlight this work.


When I began writing Overtreated in 2004, most people thought I was crazy. Everybody knew the problem in US health care wasn’t too much care, but too little. Forty million of us were uninsured and lacked adequate access to care. With the passage of the Affordable Care Act, we’ve finally begun to make sure everybody is covered. It only took us 100 years from the time Theodore Roosevelt first proposed universal health insurance!

I’m relieved to know that it won’t take that long for more people to recognize the equally damaging effects of overuse. In a 2012 article in JAMA, Don Berwick and Andy Hackbarth conservatively estimated that overtreatment (which the authors define as “care that, according to sound science and the patients' own preferences, cannot possibly help them”) accounted for between $158 billion and $226 billion in “wasteful” health care spending in 2011. Others approximate that it’s closer to a third of health care spending: the US wastes up to $765 billion every year on overuse of health care services.

But the money wasted is the least of it. Unnecessary or unwanted medications, tests, hospitalizations, and procedures can result in significant physical and psychological harm to patients. And even when patient harm does not occur, rampant overuse deprives the health care system of money that could be better spent making sure patients have care they do need, and that the nation should be investing in primary prevention. Overuse perpetuates the status quo — a system devoid of transparency, in which clinicians are paid to do more, not better, and patients are often left to fend for themselves in a convoluted mess of paperwork and difficult treatment decisions.

We’ve got to envision a better health care system. A system where less is done to the patient and more is done for the patient, where clinicians have the time they need to act as healers, and where good quality care is affordable and accessible to all Americans. We know that such a system is achievable — but it will take real change, right now.

That’s why, with the help of our RightCare Alliance network, the Lown Institute will launch RightCare Action Week (October 18-24) — a week at the end of October when clinicians all over the US will take action to highlight a specific dysfunction in health care and demonstrate to their colleagues and the public how it can be changed for the better.

Participants have pledged to engage in a number of different actions, all of them intended to shine a bright light on overuse and its effects, or an action that can prevent overuse. For example, during RightCare Action Week, medical residents will conduct a “RightCare Count,” tallying every instance of overuse they observe, and report back on their experiences during a group storytelling session at the end of the week. Other clinicians will spend a day making house calls to patients for whom office visits are particularly burdensome.

So far, hundreds of clinicians around the country have signed up. By mobilizing a committed group of change agents to demonstrate what “right care” should be, we will inspire and incite to action stakeholders at every level, and grow the movement toward care that is safe, effective, affordable, equitable, and respectful of patients’ values.

To learn more about RightCare Action Week, tune in to WIHI on October 1 at 2:00 PM Eastern Time for a discussion of “Getting Right Care, Right!”

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