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On "unnecessary" ED visits: background reading

Here are a bunch of very informative pieces on why trying to blame excessive costs or busy-ness on low acuity patients in the ED is, at be...

February 21, 2013

ACEP Chooses Wisely

Kudos to ACEP for joining the Choosing Wisely campaign! I think this is a big step forward in helping reign in unnecessary care, which not only will help our patients but also happens to save money. Note that helping patients is the priority here; saving money is nice added benefit (and will help keep other people's noses out of our professional business).

As explained briefly on The Central Line:
“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources. The campaign encourages medical specialty organizations to identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.
ACEP had considered joining 3 times before, but was concerned that and most recently had declined to join in the summer of 2012. Some concerns expressed by then-ACEP president David Seaberg include:
Many of these patients have been sent in with expressed instructions from the family physician to have this or that test ordered 
It is simply not possible for emergency physicians to talk about reducing ‘unnecessary’ testing without including messages about the need for medical liability reform.
it very well may assure that emergency physicians will not receive reimbursement for the five identified procedures or tests.
Although those concerns are not unwarranted (mostly the latter 2), I think they are generally outweighed by the benefits. As I explained in a reply on the EP Monthly re-post of the same essay by Dr. Seaberg:
Choosing Wisely is gaining national recognition for its patient-centered approach to decreasing unnecessary care. This is one major way we -- as professionals -- can decide what is appropriate for our patients. Parsimony is coming. If we don't take the lead then others will decide how we should care for our patients. As a specialty, we can define our standard of care so groups like CMS don't have to.

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