Dr. Richard J. Baron, President and CEO of the American Board of Internal Medicine and the ABIM Foundation, will deliver the Keynote Address at “Innovation Showcase: Technology Tools for the Medical Neighborhood,” on March 15. Dr. Baron will discuss the origins of the Choosing Wisely campaign, a nationwide effort to reduce waste and overuse in health care. Read more about the campaign here.
How does Choosing Wisely connect with the move toward value-based health care?
Value-based health care is a move away from fee-for-service. In fee-for-service, there’s an economic incentive to do more. Doing more generates more revenue. In general, I believe physicians and clinicians are highly professional and try to do the right thing for patients. But we know a lot of what gets done is not evidence-based, not necessary — and exposes patients to risk. We want people to choose health care wisely, and Choosing Wisely helps clinicians and patients have conversations about what health care might not be necessary. The focus is not on money but on doing the right thing for patients.
You will be speaking at the Innovation Showcase. How can technology advance the efforts of Choosing Wisely?
Choosing Wisely is a set of expert recommendations that come from folks with deep knowledge in each field. Committees of professionals with knowledge of the medical literature created the recommendations. They know what works and what doesn’t. How you move the recommendations into real life settings almost always involves some form of technology. We have the Choosing Wisely app. The app allows patients and physicians to easily search more than 500 recommendations. No one can carry all those recommendations around in their head. At the point of care, we also are seeing Choosing Wisely incorporated into Electronic Health Records. So if a doctor prescribes something against the recommendations, a prompt might come up that asks: ‘Do you really want to order this test, or this prescription?’ It is a way at the point of care for the patient and doctor to talk about what’s truly necessary for the patient.
If every clinician followed Choosing Wisely’s recommendations to eliminate unnecessary testing and treatments, what would that mean for American health care spending?
The campaign is focused on avoiding harm. Unnecessary care produces harm. Testing when it isn’t necessary also generates financial harm, especially for patients now that we increasingly live in a world of high co-pays and deductibles. The National Academy of Sciences says up to 30 percent of what we do in health care is waste. Since we spend $2.5 trillion on health care, 30 percent is a huge amount. We know in clinics where Choosing Wisely has been implemented into electronic health records we’ve seen a documented financial impact. Care that does not add value to patients gets done a lot less. The primary aim was never about reducing costs. Some have criticized us because even with Choosing Wisely there is still a lot of waste. It’s not the magic bullet for everything. But it is a highly effective tool.
Is the goal of Choosing Wisely to reach providers or patients?
It’s really aimed at both. If you talk to providers about why they do unnecessary things they’ll say that patients ask for it. ‘A neighbor with back pain got an MRI so I should get an MRI because of my back pain.’ But most people with back pain get better. The Choosing Wisely app supports the doctor who can say, ‘This recommendation shows you really don’t need that MRI.’ Patients sometimes may think the doctor is trying to save money because of a new health insurance contract or something. And the recommendations raise awareness to prevent the physician from, say, just prescribing antibiotics for a cold when that’s not the appropriate treatment.
Does following the recommendations mean doctors have more or less exposure to lawsuits?
We get that question a lot since litigation and malpractice is an ever-present risk for providers. Clinicians can get sued for anything. We know that doing more — if it’s the wrong thing to do — puts doctors at higher risk for lawsuits. It’s naive to think that doing more unnecessary tests and procedures will decrease litigation.
What will be the important takeaway from your keynote at the Innovation Showcase?
I would love for this audience to be more aware of Choosing Wisely and the variety of tools connected to the campaign. There are so many things for primary care doctors to do these days. Screen for domestic violence. Firearms in the home. Appropriate preventive care. Everybody is busy. I know many physicians now have value-based contracts. Choosing Wisely gives doctors a better way to talk about low-value care without the conversation being financially driven. Bringing money directly to the bedside does not go well for physicians or patients. Our focus is better care. Having conversations around better care for patients is the pathway for success in value-based contracts.