The Choosing Wisely campaign, choosingwisely.org, is a "game changer in American medicine," and Texas can and should be "the vanguard state" for advancing the program.
That's what Temple nephrologist Donald E. Wesson, MD, told a roomful of physicians at the Texas Medical Association's Fall Conference in September. He is past chair of the American Board of Internal Medicine (ABIM) Foundation, which created Choosing Wisely and awarded TMA a grant in 2013 to advance the program among Texas physicians. Support for the grant comes from the Robert Wood Johnson Foundation.
Choosing Wisely aims to improve quality and reduce waste by getting physicians and patients talking about medical tests and procedures that may be unnecessary and possibly harmful. So far, 60 medical specialty societies have joined the campaign and identified more than 250 tests and procedures they say are overused or inappropriate.
Dr. Wesson says the lists have been "an overwhelming success" in carrying out the campaign's goals of choosing the right care and improving care quality. He stressed, however, that the focus of Choosing Wisely "has been, and continues to be, upon the quality of the care delivered and not necessarily on the cost," although reduced costs are likely to be a fringe benefit of those efforts.
TMA, one of 23 grantees, also got a big "high-five" from Dr. Wesson for stepping up to promote Choosing Wisely in Texas. "Physician leadership is key to improving the quality of health outcomes," he said. "I commend TMA for taking leadership in doing this because physician awareness [of Choosing Wisely] is key to making this happen."
In that regard, he says the campaign, now in its third year, is off to a good start. Results from a May ABIM survey of 600 physicians nationwide show:
• One in five physicians say they are aware of Choosing Wisely;
• Of those, 62 percent say they are more likely to have reduced the number of times they recommended a test or procedure, compared with 45 percent of those who are unaware of the effort;
• Two-thirds of physicians acknowledge responsibility to make sure their patients avoid unnecessary tests and procedures; and
• Nearly 60 percent of physicians say they are in the best position to address the problem.
"So we already have physicians motivated to move in the right direction," Dr. Wesson said.
On the other hand, ABIM is working to overcome certain challenges to furthering the program, including partnering with Consumer Reports to address a lack of health literacy among patients and developing tools to help physicians hardwire the tenets of Choosing Wisely into daily practice.
With the largest and most active physician medical association in the country, Texas is positioned to be a strong partner and leader in those efforts moving forward, Dr. Wesson says, adding that tort reform helps reduce physician anxiety about reduced testing. Also, the American Academy of Nursing chose Texas as the pilot state for the nursing aspect of Choosing Wisely, creating another partnership opportunity.
"So my proposal for the TMA is that we partner on ways by which we can particularly help small physician [groups] and single discipline professions implement the tenets of Choosing Wisely," as well as multispecialty practices, he said. "I don't have the magic bullet, but TMA can help us develop it."
TMA and the TMA Foundation promote Choosing Wisely to Texas physicians in collaboration with county medical societies, the Texas Osteopathic Medical Association, and state medical specialty societies. The grant runs through March 31, 2015. For more information about the campaign, visit www.texmed.org/choosingwisely.