In today's health care climate, physicians are increasingly being asked to do their part to help contain costs and to "choose wisely" when it comes to ordering costly medical tests and services. However, a recent study led by researchers from The Dartmouth Institute for Health Policy and Clinical Practice found that while the overwhelming majority of physicians surveyed (92.2%) felt that doctors had a responsibility to control costs, less than half of the physician-respondents (36.9%) reported having a firm understanding of the costs of tests and procedures to the health care system.
The study, published in the American Journal of Managed Care, was designed to test physicians' awareness and knowledge of Choosing Wisely, an initiative of the American Board of Internal Medicine (ABIM) Foundation. The Choosing Wisely campaign was created in 2012 to help physicians better identify low-value health care services, or those that give patients little real benefit for the time and money spent.
As part of the campaign, the ABIM Foundation and partnering specialty societies create and publish lists of evidence-based recommendations, "Five Things Physicians and Patients Should Question," that help doctors and patients have more productive discussions about appropriate care based on a patient's individual situation.
Regarding physicians' attitudes toward/knowledge of low-value health services and the Choosing Wisely campaign, the study found:
- Approximately one-third of physician-respondents felt it was unfair to ask doctors to be both cost-conscious and concerned with patient welfare, and approximately one-third also say they try not to think about costs during treatment decisions. About a third also stated that doctors are too busy to worry about costs.
- Primary care physicians reported significantly greater awareness of the Choosing Wisely campaign than (47.2%) than medical specialists (37.4%) and surgical specialists (27%). Three-fourths (75.1%) of primary care physicians reported agreeing or somewhat agreeing that Choosing Wisely empowered them to reduce use of unnecessary tests and procedures as compared with 64.4% of medical specialists and 54% of surgical specialists.
- Primary care physicians reported feeling significantly more pressure from patients to order tests and procedures than medical and surgical specialties (68.3%, 58%, 55.8% respectively). They also report feeling more pressure to refer patients to consultants (65.3% vs 34.7% in medical specialties and 33.7% in surgical specialties.) Conversely, surgical specialists were more concerned with malpractice than primary care physicians or medical specialists.
To conduct the study, the researchers created a 29-item Survey on Overuse and Knowledge of Choosing Wisely and distributed it to all doctors practicing at Atrius Health — the largest ambulatory care provider in Massachusetts, serving nearly a million patients. Atrius is also a Pioneer Medicare accountable care organization.
Although the study was limited to Atrius clinicians, lead author Carrier Colla, PhD, says the findings reveal some important takeaways regarding health care cost containment and low-value care.
"Our analysis points to the fact that there is willingness on the part of physicians to forgo low-value care services, if they have appropriate support that addresses patient demand, malpractice concerns, and other drivers of overuse," Colla said. "But, it's also clear that to get a meaningful reduction in the use of low-value services, we need to engage more than just physicians. The behavior and attitudes of patients, regulators and other stakeholders all play a part in the consumption of the these low-value services."