In recent years, as healthcare reform has been hotly debated on a national level, there’s been no shortage of pundits and politicians explaining the industry’s skyrocketing costs — from medical malpractice lawsuits to overuse of emergency rooms to new high-tech, but costly, procedures. But one issue in particular has sparked a multi-state campaign that is starting to gain traction in Connecticut: unnecessary medical testing.
According to the Congressional Budget Office, an estimated 30 percent of healthcare testing in the United States is unnecessary.
Based on U.S. Census figures, that would place an excess cost per person of $2,596. If applied to Connecticut’s population of 3.5 million people that means more than $9 billion is spent on excess medical costs annually in the Nutmeg State alone.
To address the problem, a consortium of Connecticut healthcare providers, governmental organizations, consumer groups, employers and philanthropic organizations formed a partnership last fall to implement “Choosing Wisely,” a program started by the American Board of Internal Medicine (ABIM) Foundation that is designed to help physicians and patients engage in conversations about the overuse of tests and procedures. The program was based on input from a number of national medical specialty groups and has also been supported by Consumer Reports, which has conducted outreach in 22 states.
“This initiative is as much about patient empowerment and health education, as it is about reducing waste in the healthcare system,” said Victoria Veltri, Connecticut’s Healthcare Advocate and a member of the newly formed collaborative. “Only when patients are empowered will they feel they are on a level playfield field in making decisions that affect their health status and the system’s capacity to provide affordable, accessible health care.”
A big part of that empowerment starts with doctors, said Tim Elwell, president and CEO of Wethersfield-based Qualidigm, a nonprofit healthcare consultancy organization.
“It is said that the most expensive instrument in health care is the physician’s pen,” joked Elwell. He cited a national Choosing Wisely physician survey showing that 72 percent of doctors indicated the average physician prescribes at least one unnecessary test or procedure a week, and 53 percent indicate they would order an unnecessary test if a patient requests it.
Patient expectations are another part of the problem, Elwell said.
“Some patients feel their time at the doctor’s [office] is wasted if they aren’t receiving a prescription or having a test taken,” Elwell said. “Doctors and nurses may need to spend more time explaining why some procedures aren’t necessary.”
That’s where Nancy Yedlin, vice president of West Hartford’s Donaghue Foundation, which is taking a lead role in the Choosing Wisely Connecticut collaborative, hopes this initiative can help.
“Unnecessary tests expose people to possible harms and potential side effects,” she said. “Choosing Wisely is as much about improving patient safety as it is about saving healthcare dollars.”
Currently, Yedlin explained, the Connecticut collaborative is using national Choosing Wisely public service announcements, posters and toolkits to spread its message, noting that its members are still in a planning phase.
Nationally, the Choosing Wisely campaign has already targeted certain tests that should be questioned or avoided. For example, there is a recommendation for doctors to use only skin or blood tests to diagnose allergies since most other testing methods are unproven.
Connecticut participants are still trying to build consensus around goals and objectives tied to Connecticut’s specific needs, Yedlin said.
Collectively, core members of the still-evolving group have contributed $30,000 to fund a fellow who will conduct research, gather input from key stakeholders, including the business community, and pursue funding opportunities to sustain Choosing Wisely.
In addition, the collaborative will be helped this summer by a team of UConn urban health scholars, who will conduct focus groups and interviews with providers to get feedback on their antibiotic prescribing patterns and their familiarity with Choosing Wisely materials on antibiotic use for patients and doctors.
These are critically important steps, according to John Lynch, vice president of research and government affairs for Farmington-based ProHealth Physicians.
Lynch said he thinks the success of this collaborative will depend on getting input from a broad, neutral spectrum of opinions. “Patients need to understand this [cost-saving] initiative isn’t just about providers trying to gain something,” he said.
With more than 88 medical practices and 220 physicians in its network, groups like ProHealth Physicians can help educate doctors about evidence-based research and unnecessary medical testing, which can inform best practices and patient interactions, Lynch said.
In states where Choosing Wisely has launched, it seems to be slowly gaining momentum with one in five doctors aware of the campaign, Yedlin said.
“We will be talking to groups from other states [with Choosing Wisely campaigns] to learn what worked well and where there were challenges,” Yedlin said. By fall, Yedlin says, she expects Connecticut will narrow its tactical focus, based on the research and focus groups conducted this summer.
For now, Yedlin said she is encouraged by the enthusiasm and commitment she has seen from partner organizations. She knows, however, there are foundational challenges — from structure to decision-making models — that must be determined before tackling the ultimate mission.
Lynch said he agrees.
“Getting agreement from a board on what to try and measure can be its own challenge,” he said. “Consensus is not [always] easy to come by in Connecticut.”
Read more
Wethersfield healthcare consultancy partners on $53M contract
