By Richard Scott
January 19, 2012

While the medical home's chief characteristic may be thought of as patient-centered care, it may have a competitor in the ranks of attributes – namely, the notion of efficiency.

Should that be the case, the timing could not be better. As has been widely reported, the costs of healthcare are significant and are on the rise precipitously. The amount of money spent on healthcare services in the U.S. far outweighs that of other technologically advanced countries, clocking in at more than 17 percent of total economic activity – a figure expected to rise to just shy of one-fifth of the economy, or 19.3 percent, by 2019.

Here’s the kicker. According to the latest research, nearly one-third of all healthcare spending goes toward tests, treatments or procedures that do not enhance health or improve a patient’s well-being.

That estimate comes from the Congressional Budget Office. While the figure sounds shocking, some think it may underestimate the degree of waste or misuse. Dr. Glen Stream, president of the American Academy of Family Physicians, thinks the estimate “may be conservative” and points to studies of Dartmouth Atlas data that have shown a high degree of irregularity in care as evidence. In grappling with a diverse array of care across many locations, Stream tries to simplify the language of the equation.

“Some of it’s testing and some of it’s treatment, but you can consider it all ‘medical care,’” says Stream. “And that 30 percent is not contributing to people’s health. It’s testing and finding things that you can’t treat. Or it’s treatment that’s ineffective. Or, worse yet, it’s treatment that results in harm.”

Needless to say, the cost benefits of a more efficient system are huge. Two currents sweeping through healthcare have this problem lined up in their sights.

Wise Decisions, Reduced Waste

Like other initiatives that cross the divide between payer and provider, the medical home is viewed as an effective way to trim costs and improve the timeliness of care. One of the key methods it can do this is through the proper utilization of services, based on evidence-based care.

“One of the main tenets of the medical home practice is to have informed decisions based on the best medical evidence,” says Stream.

Meanwhile, an initiative from the ABIM Foundation that pursues some of the medical home’s ingrained efficiencies – dubbed simply Choosing Wisely – holds the potential for ramifications that are anything but small scale.

Originally a pilot project of the National Physicians Alliance, Choosing Wisely targets the waste or mis-utilization of services – the staggering 30 percent – that are at the heart of the CBO’s report on suboptimal practices that are affecting overall healthcare costs in a tremendous way.

In December, the Choosing Wisely campaign received a strong dose of support when nine medical specialty societies banded together to implement the campaign’s main tenets into a robust call to action. The nine societies, including the American Academy of Family Physicians, have agreed to develop evidence-based lists of tests and procedures that often mark unnecessary or questionable care. The idea is that, with a defined list, patients will have a better understanding of unwarranted care – and doctors will have an easier time talking patients out of treatments or tests that are not beneficial to their well-being.

“One of the things we have to do is squeeze out unnecessary costs,” says Stream, “so we can find those things that we do think, as a country, are going to benefit people’s health.”

The initiative calls for each specialty society to develop a list of five common tests or treatments “whose use should be discussed or questioned,” according to a news statement. As the agreement stands, the five-point lists are to be developed based on strict criteria, including: each item should fall within the specialty’s purview and control; noted procedures should be used frequently and be expensive; there must be evidence to back each recommendation. The five-points lists are scheduled to be unveiled in April 2012.

With a consistent rise in expenditures and leaders – both healthcare professionals and lawmakers – grappling with the ever-rising tide, the pursuit of new models of care that stress coordination and smart decision-making are at the vanguard of modern healthcare delivery. The medical home model, for one, has shown significant cost-savings and quality improvement. And its focus on streamlined, coordinated care makes it a mirror image for the types of interventions wrapped up in the Choosing Wisely campaign.

“Maintaining ongoing relationships with our patients throughout their lifespan helps us provide the best care possible and significantly decreases the need to order tests and procedures,” said Stream at the time of the release in December. “The comprehensive, integrated care provided through a patient-centered medical home significantly reduces duplication and eliminates unnecessary treatment. It also encourages an open dialogue between physicians and patients, which helps them ‘choose wisely’ when it comes to a treatment plan.”

Organizations participating in Choosing Wisely include:

• 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
• American Society of Nuclear Cardiology
• Consumer Reports 

For more information, visit Choosing Wisely online.    

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