WIHI: Testing,Testing! Is This Procedure Necessary?

Date: May 17, 2012


  • Daniel B. Wolfson, Executive Vice President and COO, ABIM Foundation
  • Steven Pearson, MD, MSc, FRCP, President, Institute for Clinical and Economic Review  Institute for Technology Assessment
  • Amanda Kost, MD, Acting Assistant Professor, University of Washington Department of Family Medicine
  • Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement
  • Karen Boudreau, MD, FAAFP, Chief Medical Officer, Boston Medical Center, HealthNet Plan; Former Senior Vice President, Institute for Healthcare Improvement and Medical Director for IHI Continuum Portfolio

Of all the sources of excessive health care spending, none may be higher on the list than the habit of ordering lots of expensive tests and procedures. This appetite for the best of what high-tech medicine can offer whether warranted or not is a big factor behind estimates that up to a third of health care spending in the US is wasteful and unnecessary. But everyone also has a story of someone, maybe themselves, helped by a diagnostic procedure. There’s no question that one person’s unnecessary test is another person’s lifesaver. So, how do we get closer to more appropriate use? And is there a more active role that physicians can play?

The ABIM Foundation is betting there is a way to bring the ordering of tests and procedures into better balance AND that doctors are key to making this happen. This is the premise behind the ABIM Foundation’s new campaign, Choosing Wisely. Nine medical societies are on board (with eight more joining in the fall), and they’ve each identified five procedures that tend to be overused and that should trigger discussions to ensure that they’re really needed and of value. The American Academy of Family Physicians, for example, has a list that begins with thinking twice before immediately ordering imaging for low back pain.

WIHI host Madge Kaplan has assembled a great group of experts: The ABIM Foundation’s Daniel Wolfson will explain the campaign. Karen Boudreau will help us think through the role of family practitioners, while Steven Pearson will contribute some of the latest and sharpest thinking about evidence-based medicine and comparative effectiveness. Amanda Kost got to put on her “choosing wisely” shoes a bit ahead of the game by being part of the National Physician Alliance’s Promoting Good Stewardship in Medicine project. She’ll provide some key frontline learning on best practices that can help wean doctors and patients alike from reaching for the most expensive solution, first. Finally, IHI’s Don Goldmann, will discuss how Choosing Wisely aligns with other national initiatives and why it’s crucial that the medical profession take a leading role with health care reform.

Whether or not you’re directly in the role of ordering tests or procedures, we invite you to consider that we all have a part in making health care more effective and affordable in other words, of true value to patients.



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