As multiple organizations step up efforts to encourage physicians to more wisely use clinical resources and reduce health care costs, professional organizations and consumer groups are conducting a parallel campaign to educate patients about testing and procedures that involve more cost than value.
Over the past few years, several professional organizations and publications have launched efforts to eliminate wasteful or potentially harmful medical practices. These programs include the Less Is More series from the Archives of Internal Medicine, the High Value Care initiative of the American College of Physicians (ACP), and most recently the Choosing Wisely campaign launched by the American Board of Internal Medicine (ABIM) Foundation in partnership with numerous professional medical groups. The efforts aim to identify medical tests or other procedures that are commonly used but offer little benefit to patients, to educate physicians about such unnecessary medical care, and to encourage better stewardship of medical resources.
Consumer Reports has created an online video to help patients weigh whether imaging is necessary to care for low back pain.
“We feel it's a professional responsibility to reduce overuse and misuse of medical care,” said Steven E. Weinberger, MD, executive vice president and chief executive officer of the ACP, which is also participating in the Choosing Wisely campaign, during a press briefing.
But the organizations participating in these efforts acknowledge that physicians are only one piece of the puzzle and that educating patients to be thoughtful consumers of health care is a vital step. So the ABIM Foundation and ACP have partnered with Consumer Reports to help educate patients about interventions that have been identified as being potentially unnecessary by either the Choosing Wisely campaign or the High Value Care initiative.
Kevin McKean, vice president and editorial director of Consumer Reports, noted at the ACP briefing that although it would be ideal if physicians and patients could weigh interventions based on their clinical value alone, cost is an important factor for many patients in determining whether to pursue care.
“In the real world, there are millions and millions of patients who must consider cost, through no fault of their own,” he said.
McKean noted Consumer Reports ’ long track record of casting a critical eye on health care products and services—dating as far back as the first issue in 1936, which included testing of Alka-Seltzer—as providing an excellent foundation for this new effort.
Consumer Reports, with its long history of providing evidence-based and unbiased information to consumers, plans to leverage its reputation and experience to translate the new guidelines for physicians into written or video materials for laypeople, explained John Santa, MD, MPH, an internist and director of Consumer Reports ’ health ratings center.
The patient materials will be peer-reviewed and cobranded by Consumer Reports and the professional society that created the guideline on the particular topic. The patient materials will describe why the particular intervention may not be necessary and give patients advice on steps they can take to deal with a particular issue. For example, the item on imaging for low-back pain explains: “Most people with lower-back pain feel better in about a month—whether they get an imaging test or not. In fact, those tests can lead to additional procedures that complicate recovery.”
This resource goes on to recommend steps patients can take to alleviate back pain, such as staying active, applying heat, considering over-the-counter pain relievers or anti-inflammatories, sleeping comfortably, and consulting a physician to rule out serious underlying issues or to discuss options for alleviating the pain.
All of the patient materials produced in conjunction with the Choosing Wisely and High Value Care initiatives are free at the Consumer Reports website. Consumer Reports has also established partnerships with a range of organizations, including the AARP, Service Employees International Union, and National Center for Farmworker Health, to further distribute the materials. Santa explained that Consumer Reports targeted organizations with the potential to reach at least 1 million consumers each. For example, the AARP's Bulletin reaches 28 million individuals. Wikipedia will also be working with Consumer Reports but will produce its own materials to post online.
“This is going to take a long-term commitment,” Santa said at the briefing. “Consumers' perceptions are strong that more health care is better, more expensive care is better.”
Santa said he expects to see some resistance to efforts to change consumer perceptions about the relationship between cost and value and to encourage consumers to be proactive in weighing the value of care. He said that past efforts by Consumer Reports to raise cost as an issue have met push-back from consumers.
“They are worried about mentioning to physicians that cost is an issue, because they are worried they will get [lower-quality] care,” Santa said in an interview.
But Santa said he hoped the involvement of ACP and the other professional organizations participating in Choosing Wisely will help assuage these fears. He also applauded the physician organizations for taking their fiduciary duties to patients seriously.
“More and more consumers are struggling with medical costs,” he said. “The health care industry is imposing these costs on them. We are trying to give patients some tools for dealing with those costs.”
Kuehn BM. Materials Educate Patients to Make Wise Choices on Tests and Procedures. JAMA. 2012;307(21):2245-2246. doi:10.1001/jama.2012.5341