… or is it just too early to tell?
Announced with much pomp, the ABIM Choosing Wisely campaign was picked up by many specialties. Each chose at least 5 “low value” tests reflective of unnecessary resource utilization, and such have been disseminated via press release, social medial, and web presence. The Annals of Internal Medicine further supports the endeavour by publishing original research in the same vein.
This retrospective analysis of patients enrolled in Anthem health plans evaluated the utilization trend for seven of these services over the past 3 years. And, ultimately, the conclusion is: nothing has reliably changed. Two of seven “low value” services had decreasing trends on the order of a fraction of a percentage, while two more had increasing trends on the order of a fraction of a percentage. Just to tie in with one of my all-time favorite themes, antibiotics for acute sinusitis remained stable between 84.5% and 83.7%.
So, the early report is: no one’s making wise choices.
What’s the solution? If you look around medicine for initiatives with the most robust implementation, it seems tied to either reimbursement or public shaming via quality scorecard. Is it time for a value-based care rating? Can we take all the resources devoted to Press-Ganey and repurpose them for good instead of evil?
“Early Trends Among Seven Recommendations From the Choosing Wisely Campaign”
http://www.ncbi.nlm.nih.gov/pubmed/26457643