Healthcare News & Insights

Some specialty groups aren’t playing fair creating their list of unnecessary procedures

462461267 (2)When the ABIM Foundation asked the American Academy of Orthopaedic Surgeons (AAOS) to come up with a list of unnecessary procedures in their field to contribute to the foundation’s Choosing Wisely campaign, the AAOS obliged. But unlike the other specialties, its selections seemed shady. 

Reason: Not one of their selections significantly impacted their incomes.

Memory refresher

If you remember back in April of 2012, the ABIM Foundation released a list of tests and procedures from nine medical specialty societies that patients should question doctors about when ordered as part of their care. The purpose wasn’t to eliminate these tests and treatments, but to get doctors and their patients to question their use in specific cases.

The list was meant to be used as a set of guidelines. And the tests and procedures on the list were to be ones that medical evidence showed had little or no value for certain conditions.

Last year we updated you when 17 more medical specialty societies joined the ABIM Foundation’s Choosing Wisely campaign. That made a grand total of 130 tests and procedures that are on the list and more than 350,000 physicians represented by the 26 medical societies.

Skirting the issue

The list from the AAOS recommendations covered orthotics, splints, an uncommon procedure, the use of diatary supplements and ultrasonography, none of which are going to impact orthopedic surgeons’ wallets if they were eliminated, noted an article produced in collaboration by Kaiser Health News (KHN) and the Chicago Tribune.

Here’s what the AAOS specifically recommended for patients with joint pain on the Choosing Wisely website:

  1. Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty
  2. Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief
  3. Don’t use dietary supplements glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee
  4. Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee, and
  5. Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.

“They could have chosen many surgical procedures that are commonly done, where evidence has shown over the years that they don’t work or where they’re being done with no evidence,” said Dr. James Rickert, an assistant professor of orthopedic surgery at Indiana University, told KHN. “They chose stuff of no material consequence that nobody really does.”

So why did some specialty groups not include their own procedures?

The AAOS defended its Choosing Wisely selections in a written statement saying, “our recommendations are limited by the existing evidence regarding the effectiveness of various treatment options for musculoskeletal conditions, which we are seeking to improve.”

Not playing fair

What the AAOS did hardly seems fair when specialists like gastroenterologists, radiologists and clinical pathologists all put their own tests on the list, not tests that others do. Heck, the Society of General Internal Medicine put one of its major moneymakers on the list — the annual physical exam.

Dr. Nancy Morden, a researcher at the Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, examined all the items on the first 26 Choosing Wisely lists, according to KHN. What she found was that “83% of the items targeted radiology, medications, and cardiac and lab tests — not physician services.”

For example, the American College of Cardiology didn’t address what studies suggest is the most frequent type of overtreatment in the field: inserting stents to prop open arteries of patients who aren’t suffering heart attacks, rather than first prescribing medicine or encouraging  a healthier lifestyle. And according to a study in Circulation, one out of eight of the stent procedures shouldn’t have been performed. But stent procedures are big business in cardiology.

Game changer

This list of now 54 specialty societies has become a real game changer, Dr. Donald Berwick, a former head of Medicare, told KHN. That’s because the advice comes from “pedigree physician groups,” not payors or politicians.

And some hospitals, including Cedars-Sinai Medical Center in Los Angeles, have added the list of tests and procedures to their computerized patient record system so when physician puts in an order for something on the list they’re flagged by the computer.

But hospitals aren’t the only ones using the lists. Carriers are also using them. And according to Dr. Richard Baron, president of the ABIM Foundation, “We’ve got a bunch of other countries knocking on our door.”



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