1. Choosing Wisely Or Five Ways To Save A Quick $7 Billion J. Paul Martin, MD Ann Marie Padilla, MD Alan Thomas, MD

3. IHI Triple Aim Improving the patient experience of care (including quality and satisfaction) Improving the health of the populations Reducing the per capita cost of health care

4. Reduce cost = eliminate waste  National Healthcare Costs = $2.6 Trillion $2,600,000,000,000  Waste accounts for 30% = $750 Billion $750,000,000,000

5. Primum Non Nocere  It may be better not to do something than to risk causing more harm than good  “The most successful operation is the one that never happens” Cutting for Stone

6. ABIM Foundation  April 2012 Launches Choosing Wisely  Top–five lists from 9 Specialty Societies  Over used or unnecessary procedures

9. Pediatrics  No antibiotics for pharyngitis unless strep test +  No x-rays for minor head injuries without LOC  Don’t refer O.M. w effusion early in course  Advise against cough & cold medications  Use inhaled corticosteroids in asthma

10. Pediatrics  No antibiotics for apparent viral URIs  Neuroimaging unnecessary w simple febrile sz  CT scan unnecessary in eval of simple abd. pain  Do not use medications in the “happy spitter”  Infant apnea monitors should not be routinely used to prevent SIDS

11. Family Medicine

16. Internal Medicine  No imaging for LBP for 1 st 6 wks without red flags  With simple syncope & normal neurologic exam don’t obtain CT or MRI  No screening TMSTs in asymptomatic, low risk pts  D-dimer as initial test in low probability VTE  No pre-op CXR in absence of clinical suspicion for intra-thoracic pathology

17. Others  No pre-op CXR w/o specific flags - ACR  Don’t dx or manage asthma w/o spirometry -AAAAI  No colorectal CA screening by any method for 10yrs after neg colonoscopy in ave risk pts - AGA  Avoid NSAIDs in pts w Htn, CHF, or CKD - ASN

18. Dive Medicine?  Evaluation for Patent Foramen Ovale –  Steroids/Antibiotics and Middle Ear Barotrauma  Others:

19. What would you do with $7 billion?