By Tara Bannow

The Bulletin

The Oregon Medical Association recently honored the St. Charles Cancer Center in Bend for its efforts to cut down on unnecessary testing and procedures.

The cancer center did so by making sure its practices align with recommendations from Choosing Wisely, a campaign designed to encourage communication between patients and providers around commonly overused services. The crux of Choosing Wisely, launched in 2012 by the ABIM Foundation, a nonprofit that seeks to improve health care through medical professionalism, was the creation of dozens of lists for both patients and providers aimed at detailing the circumstances in which services are and are not necessary.

Now, ABIM wants to get as many providers as possible to use the recommendations in their practices.

“It’s really about a set of professional values, about physicians taking the responsibility to being good stewards of resources — that is the basis of this campaign,” said Daniel Wolfson, chief operating officer of the ABIM Foundation. “It was directed toward doing no harm and increasing the quality and safety of medical care.”

As part of the campaign, more than 60 organizations representing different medical specialties created their own lists of practices patients and providers should question. All of the lists are featured on the Choosing Wisely website.

The OMA honored the cancer center for announcing it was reviewing its practices and educating providers in response to the lists from two medical societies focused on cancer care: the American Society of Radiation Oncology and the American Society of Clinical Oncology. Each of those lists contains 10 practices the societies said should be examined.

Dr. Linyee Chang, medical director of the St. Charles Cancer Center, said she and the other physicians started the work last year before the OMA announced its contest simply because the goals resonated with them.

“Part of best practices is not doing things that we know don’t work, that have been proven not to work, and changing practices that may be longstanding and may not necessarily be up to date,” she said.

The cancer center has so far compared its protocols against ASTRO’s first five recommendations, which warn against practices like whole breast radiation in younger women with early stage cancer without considering a shorter treatment regimen, the management of low-risk prostate cancer without active surveillance and proton beam therapy for prostate cancer.

As it turns out, the cancer center had already been following three of the recommendations, and has since gotten up to speed on the other two, Chang said. For example, with respect to the recommendation against whole breast radiation without considering a shorter treatment regimen, which delivers the same amount of radiation in fewer, higher doses, the cancer center has gone from 78 percent of eligible patients being recommended for the regimen in 2013 to 100 percent in February.

The cancer center is now reviewing ASTRO’s next five recommendations, but Chang said she doesn’t expect to find any the center isn’t already following.

“Everything on this list, they were selected by our specialty organization as practices there is strong evidence that we shouldn’t do,” she said, “so I think it’s on everybody’s radar as this is just good medicine.”

From there, they’ll dig into the ASCO recommendations.

St. Charles was one of seven organizations in Oregon the OMA selected, each of which receives a monetary award. St. Charles received the largest award: $2,000, Chang said.

Choosing Wisely’s patient-friendly lists include topics such as whether an annual physical is necessary (most of the time, no, they say) and the potential risks and hidden costs associated with tests like bone density, ovarian cancer screenings, echocardiograms and CT scans.

Many advocates have said cutting down on unnecessary tests and procedures could reduce health care waste, a massive problem the Institute of Medicine estimates amounts to $105 billion annually. But saving money is not a goal of the Choosing Wisely campaign, Wolfson said. Some of the recommendations — manual feeding over tube feeding for the elderly, for example — actually cost more, he said.

Wolfson, however, acknowledged that reducing wasteful spending is a likely byproduct of the recommendations.

In Chang’s mind, there’s no doubt about that.

“If you’re not getting tests that haven’t been shown to improve the outcomes, that’s definitely going to bring down costs,” she said.

Still, in some cases, the tests might be necessary after all, which is why Wolfson said one of the campaign’s goals is to increase communication between patients and providers.

Hospitals and smaller medical groups are now implementing the recommendations into their practices nationwide, even embedding them into their electronic medical records.

“The campaign is viral,” Wolfson said. “It has a life of its own.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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