WASHINGTON
(AP) -- Old checklist for doctors: order that test, write that prescription.
New checklist for doctors: first ask yourself if the patient really needs it.
Nine
medical societies representing nearly 375,000 physicians are challenging the
widely held perception that more health care is better, releasing lists
Wednesday of tests and treatments their members should no longer automatically
order.
The 45
items listed include most repeat colonoscopies within 10 years of a first such
test, early imaging for most back pain, brain scans for patients who fainted
but didn't have seizures, and antibiotics for mild- to-moderate sinus distress.
Also on the
list: heart imaging stress tests for patients without coronary symptoms. And a
particularly sobering recommendation calls for cancer doctors to stop treating
tumors in end-stage patients who have not responded to multiple therapies and
are ineligible for experimental treatments.
Dr.
Christine Cassel, president of the American Board of Internal Medicine, said
the goal is to reduce wasteful spending without harming patients. She suggested
some may benefit by avoiding known risks associated with medical tests, such as
exposure to radiation.
"We
all know there is overuse and waste in the system, so let's have the doctors
take responsibility for that and look at the things that are overused,"
said Cassel. "We're doing this because we think we don't need to ration
health care if we get rid of waste." Her group sets standards and oversees
board certification for many medical specialties.
The
recommendations come at a time when American health care is undergoing
far-reaching changes. No matter what the Supreme Court decides on President
Barack Obama's health overhaul, employers, lawmakers, insurers and many doctors
are questioning how the United States spends far more on medical care than any
other economically advanced country and still produces mediocre results
overall.
Until now,
the health care system has rewarded doctors for volume. Now the focus is
shifting to paying for results and coordination. That explains the urgency for
doctors themselves to identify areas of questionable spending.
It's
unclear how much money would be saved if doctors followed the 45
recommendations rigorously. Probably tens of billions of dollars, and maybe
hundreds of billions over time. That would help, but come nowhere near solving,
the problem of high health care costs.
The
nation's medical bill hit $2.6 trillion in 2010. A major quandary for
cost-cutters is that most of the spending is attributable to a relatively small
share of very sick people. Just 5 percent of patients accounted for half the
total costs among privately insured people, according to a recent study from
the IMS Institute for Healthcare Informatics.
Dr. James
Fasules of the American College of Cardiology said the goal is to begin
changing attitudes among patients and doctors.
"We
kind of have a general feeling that if you don't get a test, you haven't been
cared for well," said Fasules. "That has permeated American culture
now." The new advice isn't meant to override a doctor's judgment, Fasules
added, but to inform and support decisions.
The
recommendations will be circulated to consumers and doctors by a coalition
calling itself Choosing Wisely, which includes employer groups, unions, AARP
and Consumer Reports. Neither the insurance industry nor the federal government
was involved in process.
Each of the
nine medical societies submitted five tests or treatments they viewed as
overused. Their work was coordinated by a foundation that's an offshoot of
Cassel's group. Eight other medical societies are developing additional
recommendations, Cassel said.
The medical
societies don't have any power of enforcement, and fear of malpractice lawsuits
may well prompt many doctors to keep ordering as many tests as ever.
Insurers
will certainly take a close look at the recommendations, but what they do may
be limited. That's because most of the questionable tests and treatments in the
lists don't particularly stand out in the avalanche of bills processed daily by
insurance companies.
Take a
recommendation for no annual EKGs for low-risk patients with no heart symptoms.
Dr. John Santa, director of the Consumer Reports Health Ratings Center, said he
used to routinely order EKG's when he was a general adult medicine
practitioner. EKGs cost $50 to $60. A medical assistant would do the tests, and
it would take Santa just a couple of minutes to read them. Yet 2 percent to 3
percent of his income came from EKGs, enough to make a difference in a tight
year.
"It's
very difficult for an insurance company to tell the difference when an EKG is
being used as a diagnostic tool and when it is being used as a screening
test," said Santa. "It would probably cause more trouble for
insurance companies."
The medical
groups that participated are: American Academy of Allergy, Asthma &
Immunology; American Academy of Family Physicians, American College of
Cardiology, American College of Physicians, American College of Radiology,
American Gastroenterological Association, American Society of Clinical
Oncology, American Society of Nephrology, and American Society of Nuclear
Cardiology.
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