Choosing Wisely — The Politics and Economics of Labeling Low-Value Services

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With its Choosing Wisely campaign, the American Board of Internal Medicine (ABIM) Foundation boldly invited professional societies to own their role as “stewards of finite health care resources.” Beginning in 2009, the National Physicians Alliance, funded by the ABIM Foundation, guided volunteers from three primary care specialties through the development of “Top Five” lists — specialty-specific enumerations of five achievable practice changes to improve patient health through better treatment choices, reduced risks and, where possible, reduced costs. In April 2012, the effort was expanded and launched as the Choosing Wisely campaign, with lists from nine specialty societies and a patient-education component led by Consumer Reports. The vision was for societies to develop lists entitled “Five Things Physicians and Patients Should Question” to “spark discussion about the need — or lack thereof — for many frequently ordered tests and treatments.”1 In 2013, additional societies and consumer groups joined the effort; there are now more than 40 specialty-specific lists and more than 10 “consumer partners.” On the surface, the creation of low-value–service lists suggests that physicians are willing to make recommendations to improve health care value even against their own financial interests. The services included on the lists, however, vary widely in terms of their potential impact on care and spending.

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