The Effectiveness of “Choosing Wisely Campaigns” in the USA

In 2017, healthcare costs reached a record high of $3.5 trillion, or $10,739 per person [1]. The Institute of Medicine estimates that 8% of the total was “wasteful care.” [2] This care comes at the cost of the US’ ability to invest in other crucial sectors, such as education.

So, what causes “wasteful care”? In part, it may be driven by “a lack of scientific evidence or clear-cut decisions[, which creates] uncertainty for physicians.” [3] Additionally, there may be a belief among physicians that more care equates to better care, when this is often not the case. Finally, the US healthcare system primarily uses a fee-for-service payment model, which pays physicians for the quantity of care provided rather than the quality of care, incentivizing physicians to provide unnecessary care. All three of these factors lead to an overutilization of services that drives up the cost of healthcare.

In the attempt to slow the increase in healthcare spending, the Choosing Wisely Campaign was created in 2012 as a “physician-driven effort to create conversations between physicians and patients around overuse” of services [4]. The campaign works to provide recommendations, by specialty, of procedures that “provide minimal clinical benefit to patients in most situations.”4 The campaign also seeks to unite stakeholders in other sectors of healthcare, such as insurers and health administrators, under the goal of reducing healthcare spending.

It is not clear whether the campaign has achieved its goal. Of seven low-service value services analyzed by Rosenberg and her team from Healthcore (a healthcare economics research company), only two showed a statistically significant, modest decrease in cost [4]. There have yet to be significant results regarding cost decreases for measures of quality and safety towards more high cost but low value services offered by physicians [4].

Another study found that the Choosing Wisely Campaign focused on parts of care that contributed so minimally to healthcare spending that reducing their use did not make a difference. For example, when asked to give a list of care that provides minimal clinical benefits, the American Academy of Orthopaedic Surgeons’ suggested cutting back on preventive care expenditures such as custom shoe inserts, saline solutions, and dietary supplements. They avoided focusing on addressing the costs of surgical procedures that bore no evidence of improvement5 because continuing to perform these procedures was in their own financial interests — a sickening realization for the Choosing Wisely Campaign.

Despite its limited success, Rosenburg and her team argue that the Choosing Wisely Campaign is an encouraging initial step to health care reform, with the mission gaining momentum stateside and worldwide [4]. Although Choosing Wisely Campaigns haven’t shown any conclusive results, they show promising growth: the overutilization of care is finally becoming part of the conversation. American healthcare is finally working toward cost efficiency without sacrificing quality.


References:

  1. National Health Accounts Historical. (2018, December 11). Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Report s/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Institute of Medicine, Committee on the Learning Health Care System in America In: Smith M, Saunders R, Stuckhardt L, McGinnis JM, eds. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: National Academies Press (US), 2013.

  2. Wennberg, J. E. (1996). ​The Dartmouth Atlas of Health Care 1999​. (M. M. Cooper, Ed.). Chicago: American Hospital Association. Retrieved from https://www.dartmouthatlas.org/downloads/atlases/96Atlas.pdf.

  3. Rosenberg, A., Agiro, A., & Gottlieb, M. (2015, December 1). Trends in Use of Seven Low-Value Health Care Services. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2457401​.

  4. Rau, J. (2014, April 16). 'Choosing Wisely' Lists Don't List Big Moneymakers. Retrieved from https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/45286.

  5. Levinson, W., Born, K., & Wolfson, D. (n.d.). Choosing Wisely Campaigns: A Work in Progress Health. Retrieved from ​https://jamanetwork.com/journals/jama/fullarticle/2679354​. JAMA. 2​ 018;319(19):1975-1976. doi:10.1001/jama.2018.2202

  6. Trends in health care spending. (n.d.). Retrieved from https://www.ama-assn.org/about/research/trends-health-care-spending​

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