Viewpoints in JAMA




Choosing Wisely - Low-Value Services, Utilization, and Patient Cost Sharing


Kevin G. Volpp, M.D., Ph.D., of the Philadelphia Veterans Affairs Medical Center, and colleagues examine the recent Choosing Wisely initiative, which aimed at "encouraging physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm."

“The Choosing Wisely initiative represents an important first step toward the identification of low-value services, more meaningful because it was a step taken jointly by consumer groups and professional specialties. The next step is to move beyond a list of low-value services toward the testing of approaches to reduce their use, ideally through a combination of benefit design, physician payment policies, and social and professional guidance informed by clinical evidence. Given fiscal realities, reducing low-value services is what will allow continued support for the coverage of high-value services.”

(JAMA. 2012;308[16]:1635-1636.


What's Needed Is a Health Care System That Learns - Recommendations From an IOM Report


Mark Smith, M.D., M.B.A., of the California HealthCare Foundation, Oakland, Calif., and co-authors were members of an Institute of Medicine (IOM) committee that produced the recent report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. In this Viewpoint, the authors discuss several recommendations from this report for improving the U.S. health care system.

“The stakes are high. Left unchanged, the U.S. health care system will continue to provide world-class services to some, while others will receive substandard care and experience unnecessary harms. Spiraling costs will continue to strain national, state, and local government; corporate; and family budgets. The actions required to reverse this trend will be notable, substantial, highly disruptive—and absolutely necessary. The choice is not whether or when to begin the overdue transformation, but how.”

(JAMA. 2012;308[16]:1637-1638.