Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?

Abstract

QUESTION ASKED: What is the concordance with ASCO and the American Society for Therapeutic Radiology and Oncology Choosing Wisely (CW) measures and the cost associated with nonconcordance?SUMMARY ANSWER: Baseline concordance with selected CW measures ranged from 39% to 94%, with marked variability by cancer center. Nonconcordance was associated with higher total Medicare costs for every measure. WHAT WE DID:We conducted a retrospective analysis of Medicare claims data from 2012 to 2015 to examine concordance between care received and nine CW (six ASCO and three American Society for Therapeutic Radiology and Oncology) recommendations, as well as the associated implications for cost of care.WHAT WE FOUND: Concordance varied by CW recommendation, ranging from 39% to 94% across the University of Alabama at Birmingham Health System Cancer Community Network. Significant variability was noted in concordance across centers for all CW recommendations, with as much as an 89% difference in concordance rates between cancer centers. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. CONFOUNDING FACTORS:Claims-based analysis is limited by the inability to discriminate whether lack of concordance is the result of appropriate clinical indications or clinical trial participation. REAL-LIFE IMPLICATIONS:These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by cancer centers, rather than by patient factors, continued provider and patient education about these low-value services is needed to improve the value of cancer care.

Variation in the use of advanced imaging at the time of breast cancer diagnosis in a statewide registry

“…One possibility is the Choosing Wisely campaign itself and the associated media coverage, although rates of testing in Michigan appeared to start decreasing before the publication. 9,13,20 Those sites with the highest percentage of nonconcordant testing of patients with stage II disease treated fewer patients compared with those with lower rates of testing, although numerous other sites that treated smaller numbers of patients also had low rates of testing. 11 Furthermore, numerous studies have demonstrated a significant lag in the uptake of new guidelines or findings by physicians following their initial publication or presentation.…”

“…These findings support and extend those reported in the literature. [9][10][11][12][13] The Choosing Wisely recommendations were developed to reduce the use of advanced imaging in asymptomatic patients with newly diagnosed stage 0-II breast cancer because of the minimal benefits and potential harms of testing. The likelihood of having metastatic disease in this setting has been demonstrated to be less than 2% in multiple studies.…”

Minimizing the burden of cancer in the United States: Goals for a high‐performing health care system

“…Choosing Wisely is another attempt to bring attention to the problem of waste in health care testing and treatment; the American Board of Internal Medicine launched the Choosing Wisely Campaign in 2012 . Leading medical specialty societies were asked to identify tests, procedures, and treatments that are commonly used and often unnecessary.…”

“…Choosing Wisely is another attempt to bring attention to the problem of waste in health care testing and treatment; the American Board of Internal Medicine launched the Choosing Wisely Campaign in 2012. 29 Leading medical specialty societies were asked to identify tests, procedures, and treatments that are commonly used and often unnecessary. The American Academy of Family Physicians suggested limiting some practices related to cervical, prostate, and testicular cancer screening, and some recommendations vary by professional society.…”

Outpatient surgical care in sub‐Saharan Africa: Learning points for low‐ and high‐income settings

“…Despite marked differences in resources, cultures, and environments, hospital systems in countries of all income levels continuously work to improve the quality of patient care . New perioperative pathway development requires thoughtful planning and careful implementation to limit unforeseen negative consequences, maximize positive impacts, and promote patient‐centeredness .…”