Is This Test Really Necessary?

New lists help guide medical discussions

by David Wetzler, Senior Benefits Consultant
  

At a time when the health care and health insurance industries are under intense scrutiny, nine U.S. medical societies have developed lists of "Five Things Physicians and Patients Should Question" to improve care and eliminate unnecessary tests and procedures.

The intent of the initiative is to help patients choose care that is supported by evidence showing that it works for patients like them; is not duplicative of other tests or procedures already received; won’t harm them; and is truly necessary. The effort has been championed by the Choosing Wisely initiative of the American Board of Internal Medicine (ABIM) Foundation*, as well as Consumer Reports.

For example, number one on the list of The American Academy of Family Physicians is:

• Don't do imaging for low back pain within the first six weeks, unless red flags are present. Red flags include, but are not limited to severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits.

Choosing Wisely is part of a multi-year effort of the ABIM Foundation to help physicians be better stewards of finite health care resources. It continues the principles and commitments of promoting justice in the health care system through a fair distribution of resources set forth in "Medical Professionalism in the New Millennium: A Physician Charter.”

The new lists are being issued at a time when many payers (employers, Medicare, Medicaid, states and local governments) are struggling to reduce their health insurance costs. But such efforts run the risk of the payer being accused of rationing care. Such a charge was leveled at Medicare in 2010 when it opened a National Coverage Determination on the prostate cancer therapy Provenge (sipuleucel-T).  And many questioned the FDA’s late 2011 decision to revoke the breast cancer indication for Avastin (bevacizumab). 

We would love to hear what you think about these lists.

1. Do you agree that certain tests and procedures are, in fact, overused and unnecessary?
2. Do you think accusations of rationing may follow from publication of these lists, or is this a rational step to reduce costs and promote meaningful conversations with our physicians?
3. Should employers make these lists available to their plan participants?

Feel free to email me your thoughts, at dwetzler@SRABenefits.com. 

*To learn more about the ABIM Foundation, visit www.abimfoundation.org.