Private sector pursues cost-cutting medical comparisons on its own as health law falters in court

The private sector is moving full speed ahead with recommendations about unnecessary medical tests and procedures even as the healthcare reform law's investments in so-called "comparative effectiveness research" hang in jeopardy at the Supreme Court.

Nine physician specialty organizations representing 375,000 physicians on Wednesday will unveil 45 commonly used tests and procedures they say are often unnecessary and should be questioned by doctors and patients.


The "Choosing Wisely" campaign, which seeks to address one of the root causes of the high cost of healthcare in the United States, is spearheaded by the ABIM Foundation and Consumer Reports. The Institute of Medicine (IOM) has estimated that as much as 30 percent of healthcare in the United States is wasted.

"This is an independent effort … but it's all part of the same realization that the public and the government and frankly the whole private sector recognizes, which is that the costs of care are unsustainable," said Christine Cassel, president and CEO of the ABIM Foundation, which aims to advance medical professionalism. "What this effort does is it puts specific kinds of tests and treatments that are identified by the specialists in that field."

Cassel said the new campaign aims to inform both physicians and patients, who are often "barraged with advertising," about the latest drugs and devices.

"That really will enhance patient engagement and frankly consumer trust of these efforts," she told The Hill, "because that's, I think, one of the unfortunate aspects of all the rhetoric about rationing, which is that it unnecessarily -- and incorrectly -- frightens the public and consumers in particular, so that they then don't trust [physicians]."

The health law's independent Patient-Centered Outcomes Research Institute tasked with testing what works and what doesn't in the healthcare sector was one of the most controversial aspects of the law because of fears that it could lead to Medicare and Medicaid refusing to pay for some treatments. Cassel said that part of the healthcare debate was "very constructive," as "painful and often distorted and misleading as some of it has been."

"Hopefully we'll be able to overcome some of this fear-mongering about rationing," she said. "This is not rationing; this is about not doing things that aren't going to help you and, from the physician's perspective, often can put the patient at risk of harm."

Even if the Supreme Court strikes down the law or Congress repeals it, she predicted, private health plans will continue their shift toward rewarding better quality care instead of paying for volume.

"Their business model was in the fee-for-service system where more is better," Cassel said. "What everybody is realizing now is that more is actually not always better and we need to have a better informed approach about how we make our choices."