Is the Choosing Wisely® Campaign Making a Difference?

Laurie Scudder, DNP, NP; Richard J. Baron, MD

Disclosures

June 09, 2014

In This Article

Editor's Note: Choosing Wisely®, an initiative of the American Board of Internal Medicine (ABIM) Foundation, launched in April 2012 with 9 specialty societies and an ambitious goal of promoting discussions between physicians and patients that would lead to a reduction in the use of unnecessary test and procedures. In only 2 years, the campaign has grown to include over 60 national healthcare provider organizations, including those representing physicians, nurses, dentists, and physical therapists. The campaign also includes Consumer Reports Health, which is leading the consumer communications program by providing a variety of resources and working with more than 15 consumer organizations to engage patients and clinicians in important conversations about appropriate use of healthcare resources.

The ABIM Foundation recently surveyed physicians across the United States about their awareness of the effort, their own understanding about the issue of unnecessary tests and procedures, and their views of the causes. In a wide-ranging conversation, Medscape spoke with Richard J. Baron, MD, Chief Executive Officer and President of ABIM and the ABIM Foundation, about the survey results, the ABIM Foundation's efforts to disseminate recommendations from the campaign partners, the impact of the campaign on healthcare resource utilization, and his response to criticisms of the effort.

Medscape: Can you briefly review the history of the campaign, including numbers of partners and recommendations?

Dr. Baron: Choosing Wisely has roots in the Physician Charter, a charter on medical professionalism, which was a joint product of the ABIM Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine in 2002 to define a new code of ethics for the 21st century. The charter called out stewardship of scarce resources and concern for the health of the community as an explicit responsibility for physicians.

Those were pretty new expectations for physicians. Even when I trained in the 1980s, many physicians were taught that it was corrupt or immoral or inappropriate to ever think about resources or cost. You were only supposed to be thinking about the patient in front of you and do everything for that patient.

Choosing Wisely began when the ABIM Foundation, whose mission is to improve healthcare by strengthening medical professionalism, looked at the Charter and realized that we did not have a good framework for physicians to talk about the business of managing resources, and the physician's responsibility in that regard, or for patients to understand those conversations. The idea behind Choosing Wisely was to promote conversations between healthcare providers and patients about utilizing the most appropriate tests and treatments and avoiding care where the harm might outweigh the benefits.

I do not think we appreciated how much was going to happen over the first few years of the campaign, and how much of the focus in US healthcare was going to shift toward the health of populations and communities. The triple aim of the national quality strategy is improving health, improving patient experience, and decreasing total cost of care. Choosing Wisely launched around the same time that that was happening with 9 society partners. The first lists of recommendations were released in April 2012. That was followed by 16 additional partners releasing lists in February 2013. Then, this past fall, another 30 societies came on board.

The idea was always to engage medical professionals in thinking about things that we may be doing too much. The classic model for guideline development was for doctors to say that if a patient has hepatitis C, what are all the things we ought to be doing for our patient with hepatitis C? This was the first time that we asked a medical society to sit down and think about this question: Are there things that we are doing more of in our discipline than we ought to be doing?

The way that the Foundation approached professional societies was with only 4 core expectations for these recommendations. First, the test or procedure has to be something within your control, within your discipline. We did not want professional societies to talk about what other people ought to be doing. We wanted them to talk about what their own members ought to be doing. Second, recommendations should be something for which there was evidence that supported the conclusion that the test or procedure was overused. Third, recommendations should be about something that is happening enough in your discipline to matter -- and that could either be the frequency or the cost. The fourth requirement was that societies had to be transparent about how they selected their lists.

The core product for each society was a list of 5 things that were perhaps being done too much within their discipline. We partnered early on with Consumer Reports® so that we would have a way to translate the recommendations from medical language to more direct language that would be accessible to patients.

The effect was that the Choosing Wisely lists come to patients and physicians with the joint imprimatur of a professional medical society and Consumer Reports, a very trusted name in the consumer world. The combination of those 2 things has made the Choosing Wisely lists very relevant. Now when doctors, health systems, or patients use them, the skepticism that patients might have, a worry that a decision was based on cost or factors other than what is in the patient's best interest, is addressed.

Interestingly, this was a question that patients did not ask very much when doctors were paid for doing more. The authority of those professional societies and a trusted consumer organization makes the recommendations much more credible, believable, and trustworthy than they otherwise would be. We believe this promotes more patient buy-in and gives patients access to resources that make it simple.

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