Health care accounts for a large, and escalating, proportion of the gross domestic product, yet the overall value of many of these expenditures is unclear. The Institute of Medicine estimates that $750 billion could be saved annually by reducing health care inefficiencies, including $210 billion by eliminating unnecessary services.1 A recent attempt to reduce these unnecessary services, the Choosing Wisely campaign aims to stimulate a conversation between physicians and patients about the necessity of tests, procedures, and medications. The initial Choosing Wisely lists, including 1 from the American Academy of Neurology (AAN),2 represent an essential first step in the reduction of waste. Moving forward, physicians can choose even more wisely. To do so requires a framework for the complex task of prioritizing waste reduction targets out of the innumerable combination of tests, procedures, and medications.
Callaghan BC, Burke JF, Feldman EL. How Neurologists Can Choose (Even More) WiselyPrioritizing Waste Reduction Targets and Identifying Gaps in Knowledge. JAMA. 2014;311(16):1607-1608. doi:10.1001/jama.2014.1021