It is well-known that healthcare in the United States is too expensive and rising too quickly. The single causal factor that gets the least attention is the amount of care that is delivered that is simply wrong or wasteful, commonly referred to as “inappropriate care.” According to some studies, inappropriate care wastes up to 30% of the total health care spend in the U.S.

Thus, the most critical recommendation I can make for the new administration to focus on is elimination of inappropriate care. Eliminating this waste would enable the country to have the funds necessary to expand coverage without increasing costs above the current level and would keep patients from harm. The administration should motivate clinicians to practice evidence-based medicine through an increased level of transparent reporting. In addition, any agenda should include encouraging aligned payment methodologies that reward providing only appropriate care.

Who decides what care is appropriate? We already know. In 2012, the American Board of Internal Medicine launched its “Choosing Wisely” campaign. This initiative is based on output from over 70 medical specialty societies detailing care that is supported by evidence – and care that is not. These well-researched recommendations encourage doctors and patients to discuss tests and procedures that often are overused, misused, unnecessary, or downright harmful.

The horrifying fact is that even though the medical societies determined what care should not be provided because it lacks an evidential basis or harms patients, the societies do little to keep their own members from practicing bad medicine. The result: we continuing to add costs while harming or at least not helping, patients. 

Choosing Wisely is just one example of vehicles which could be used by the administration or others to identify and eliminate inappropriate care. Let’s conserve our healthcare dollars not by withholding care that patients need, but by avoiding treatment that they don’t. 

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