2012-03-23 20:21:24 UTC

AGA Pledges to Educate the Public on the Misuse of Tests and Procedures

March 23, 2012


Lawrence R. Kosinski, MD, MBA, AGAF

Chair, AGA Institute
Practice Management and Economics Committee

In December 2011, the AGA joined the American Board of Internal Medicine (ABIM) Foundation, Consumer Reports and eight leading medical specialty societies to identify overuse or misuse of tests or procedures:

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians 
  • American College of Cardiology 
  • American College of Physicians
  • American College of Radiology
  • American Society of Clinical Oncology
  • American Society of Nephrology
  • American Society of Nuclear Cardiology
  • Consumer Reports

The goal of the campaign, Choosing WiselyTM, is to help physicians, patients and other health-care stakeholders think and talk about overuse or misuse of health-care resources in the U.S. AGA’s participation in Choosing Wisely is a natural extension of our years of work defining quality GI care and giving gastroenterologists tools for working with patients.

The issue

Five Things Physicians and Patients Should Question
1. For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals.
2. Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
3. Do not repeat colonoscopy for at least five years for patients who have one or two small (< 1 cm) adenomatous polyps, without high-grade dysplasia, completely removed via a high-quality colonoscopy.
4. For a patient who is diagnosed with Barrett’s esophagus, who has undergone a second endoscopy that confirms the absence of dysplasia on biopsy, a follow-up surveillance examination should not be performed in less than three years as per published guidelines.
5. For a patient with functional abdominal pain syndrome (as per ROME III criteria) computed tomography (CT) scans should not be repeated unless there is a major change in clinical findings or symptoms.

Download the full list, accompanying evidentiary statements and sources here: http://bit.ly/HcZ7Nk.

The biggest driver of health-care cost is the physician’s pen. The Congressional Budget Office estimates that up to 30 percent of care delivered in America goes toward unnecessary tests, procedures, medical appointments, hospital stays and other services that may not improve people’s health — and in fact, may actually cause harm. If current trends remain unchanged, CMS projects U.S. health-care spending will reach $4.3 trillion and account for 19.3 percent of the nation’s gross domestic product by 2019.

Current health-care delivery in America is wasteful and must be fixed. Some physicians say they struggle to address waste and overuse in their own practices. Many face difficult decisions about prescribing tests and treatments that may not be necessary, but they do it to “cover their bases.” And, patients often request tests and treatments even though they might not be necessary.

It is urgent that physicians and patients work together to make wise treatment decisions. That means helping patients choose care that is supported by evidence showing that it works for patients like them, is not duplicative of other tests or procedures already received, will not harm them, and is truly necessary.

The campaign

To get physicians and patients started on talking about the issue, each society that is part of Choosing Wisely developed a list of five common tests, procedures or interventions whose use in the field should be discussed or questioned.

John Inadomi, MD, AGAF, chair of the AGA Institute Clinical Practice and Quality Management Committee, and I led the group that developed the list for gastroenterology (see figure), which was unveiled in early April at an event in Washington, DC.

AGA’s commitment

We recognize that patients often ask for tests and treatments that are not necessarily in their best interest, and physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases. However, in many cases, more care is not always higher quality care. The evidence is overwhelming that our extraordinary level of health-care spending is not delivering on either quality or value, and we are committed to playing a constructive role in addressing health-care costs.

We hope that through our partnership with the specialty societies, we significantly impact the health-care system. We simply cannot afford to do nothing.

Dr. Kosinski had no conflicts to disclose.

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