Physicians push for fewer tests

April 5, 2012

A surprising campaign called Choosing Wisely launched this week. Nine of the nation’s top medical societies joined together to put their support behind the effort to cut the number of unnecessary medical tests. The campaign marks a turning point for the practice of medicine in an economy that devotes 17 percent of its resources to curing illness, the highest level in the world. Previously, efforts to rein in medical spending have been led by health management organizations (HMOs) and other groups responsible for the payment of healthcare. It is a big shift for healthcare providers to take the lead in reining in costs.

States are increasingly burdened by their responsibility to provide healthcare through the Medicaid program, which serves over 58 million people. The new direction that Choosing Wisely advocates has the potential to lessen the strain on state budgets, as CBS News reports:

Doctors from nine of the top medical societies in the country are warning patients and fellow doctors to choose wisely when it comes to 45 common medical tests.

Some doctors may be used to prescribing these seemingly “routine tests,” but the “Choosing Wisely” initiative from the American Board of Internal Medicine Foundation says these procedures are often unnecessary and besides driving up the country’s skyrocketing health care costs, can put patients at risk.

According to The New York Times, up to one-third of the $2 trillion of annual U.S. health care costs is spent on unnecessary hospitalizations and tests, ineffective new drugs and medical devices, unproven treatments, and unnecessary end of life care.

It’s unlikely that the American underclass that relies on Medicaid is getting gold-plated treatments, but generally states do not mandate or prohibit care. One recent exception to this rule of thumb occurred in Washington state, when the Medicaid agency moved to block payments for 500 medical treatments provided in hospital emergency rooms.

A recent Government Accountability Office report highlighted the strain for municipal governments:

In the long term, the decline in the sector’s operating balance is primarily driven by the rising health-related costs of state and local expenditures on Medicaid and the cost of health care compensation for state and local government employees and retirees.

In addition to the fiscal burdens places on them by the Medicaid mandate, state and local governments are also faced with implementing the Affordable Care Act, which requires that each state establish a “healthcare exchange” to allow the uninsured to pay for access to insurance. Some public officials, like Pennsylvania Secretary of Public Welfare Gary Alexander, believe that the ACA could add substantial numbers of people to the Medicaid rolls. He estimated that an additional 800,000 citizens would be added to those of his state by 2019.

There is an enormous fiscal collision coming in the U.S. as the nation’s healthcare system is reshaped. This new campaign by physicians is the most promising change I have seen yet to get the nation’s health system on a more sustainable footing. Physicians must work to regulate the cost burden of healthcare, or bureaucratic parties will do it for them.

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