Is this what ABIMF"s Choosing Wisely is really all about?

Dr. John Benson Jr, Emeritus President  of the American Board of Internal Medicine Foundation,makes it clear  what direction he wants the Choosing Wisely  (CW)  Campaign to go. See here for his comments.

 Dr. Benson begins his policy prescription with a gratuitous assertion which seem to be a favorite technique of the folks at ABIMF. (Their mother-of-all gratuitous assertions was that physicians were stewards of medical resources.)

 "The prospect of health care consuming 20% of the GDP by 2020 is unconscionable so corrective actions have enormous urgency."  

This recent commentary from The NEJM seems to share some of Dr. Benson's views which is basically "If you people do not do what we know is right someone needs to make you do it". He speaks of penalties.

He wants the CMS to enforce the  Choosing  Wisely 's wisdom.The NEJM article speaks of linking compliance with MOC ( Maintenance of Certification)as well as tying CW recommendation to CMS actions.

Quoting Dr. Benson:

"The time is well past exhortation. The issue has been recognized for decades. Hard choices and penalties must go beyond training the next generation. 2020 is closing in." ( He does not explain the ominous reference to the year 2020).

He continues

" CMS, which has the ultimate negotiating position in the form of reimbursement for Medicare services, could only accept negotiated bundled charges. It could also refuse payment for non-compliance with the Choosing Wisely recommendations."  (note the current President of ABIM and ABIMF is Dr. Richard Baron who left a post at CMS through the revolving door to assume his duties at ABIM and ABIMF)

and it gets worse

" ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC." (Maintenance of Certification)

So, a candidate for ABIM certification would have to properly quote the Choosing Wisely catechism before he even gets to take the certification of MOC examination.

Quoting the NEJM article by Dr N.E. Morden and her co-authors from Yale and Harvard:

"..physician-endorsed low-value labels will probably be leveraged to these purposes. [cost containment and quality measures]...We believe that if such efforts are designed and applied carefully they should be embraced as a promising method for reducing low-value services."

...linking the lists ( of tests and procedures not to do ) to specialty specific maintenance of certification act activities such as practice audits and improvement tasks could also advance their dissemination and uptake at very low cost."

"...Choosing Wisely items should also be incorporated into quality-measurement efforts such as Center for Medicare and Medicaid Services Physician Quality Reporting  ...linking low value service use to financial incentives ( translate penalties )  .. should accelerate ...into practice changes."


Remember the CW campaign,which was very low key in 2009. was just to get a dialogue going   so that  the physicians could explain to their patients how at least some of these tests and treatments really don't need to be done because they may be wasteful and sometimes harmful. In 2012 the program was ramped up as the ABIMF "invited various medical professional societies to take ownership of their role as "stewards of finite health resources". And now , in 2014 the movement to give the CW recommendations teeth is ramping up.


The coercive recommendations of Benson and the authors of the NEJM article are in the tradition of those who believe that medical care is too important ( and complex) to be left to the short sighted individual patient and her knowledge and the wisdom challenged physician health care provider.They seem to march to the drum beats orchestrated by  Dr. Don Berwick (the temporary head of CMS) and  Dr.Troyen Brennan (the current executive VP of CVS Caremark) who said in their book, New Rules:

"Today, this isolated relationship[ he is speaking of the physician patient relationship] is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines...

 
Berwick and Brennan must be pleased as largely through the efforts of ABIMF and ACP much has been accomplished   in the reformulation of  traditional medical ethics. Those organizations  have shaped the narrative to emphasize the bogus stewards-of- resources concept while letting the fiduciary role of the physician to the patient fall  quietly down the memory hole.Unfortunate  the leaders of other medical professional societies have swallowed the bait.

The progressive medical elite who hold positions variously at major medical societies and medical certification boards ,some of whom rotate through various government medical agencies and sometimes private third party payers, have not been shy about what they want to happen.For those of us who believe that the patient is best served by a physician acting as fiduciary to the patient and advocating for him have much to worry about.

 Addendum:Minor editorial changes to correct some grammar and spelling done on 6/8/2014 and again on 7/23/2014.