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VA physician writes on lowering health care costs


X-rays or other imaging tests for lower back pain are one example of medical testing that is common yet unnecessary in many cases, according to VA's Dr. Eve Kerr and other experts with the Choosing Wisely initiative.
X-rays or other imaging tests for lower back pain are one example of medical testing that is common yet unnecessary in many cases, according to VA's Dr. Eve Kerr and other experts with the Choosing Wisely initiative. (Photo: ©iStock/julos)

X-rays or other imaging tests for lower back pain are one example of medical testing that is common yet unnecessary in many cases, according to VA's Dr. Eve Kerr and other experts with the Choosing Wisely initiative. (Photo: ©iStock/julos)

In a Dec. 11, 2014, article in the Harvard Business Review, VA physician Dr. Eve A. Kerr and co-author Dr. John Z. Ayanian offer their thoughts on how to minimize waste in American health care. Kerr is the director of VA's Center for Clinical Management Research in Ann Arbor, Mich.

The authors cite an Institute of Medicine estimate that unnecessary services represent about 10 percent of all U.S. health care spending—nearly $300 billion a year. While many of the millions of health care decisions made each day are well-informed by clinical evidence and expertise, others are driven by "habit, hunches, or misaligned economic incentives," leading, they claim, to substantial overuse of unnecessary, even harmful, services.

To keep patients from receiving unnecessary health care, and physicians from providing it, Kerr and Ayanian discuss the Choosing Wisely initiative, a campaign by the American Board of Internal Medicine (ABIM) Foundation. The initiative aims to promote conversations between health care providers and patients by helping patients choose care that is supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary.

Choosing Wisely focuses on putting quality in the context of quality; changing how quality is managed; helping doctors reconceive the value of their services; and re-envisioning payments and pricing. "Together," the authors write, "doctors and patients can choose a less wasteful approach as they aim to improve both the quality and efficiency of health care."


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