Medical knowledge has increased exponentially in the last decade and clinical knowledge doubles as fast as every two years. Cutting edge surgeries, cures for once-devastating diseases, and tools to manage chronic illness have all been great boons to society, allowing longer, more productive lives. But with all this knowledge looms a larger debate, when are we doing too much and how do we decide?

Several decades ago, utilization review was as essential to health care discussions as quality and patient safety are today, but as it became synonymous with cost-cutting, there has been less vigorous review of appropriateness. However, health care resources are finite; if we don't explicitly manage them, we will likely increase care disparities. As health care becomes more complex and technology-driven, it is important that we not fall under the spell of over-diagnosing and treating those things that have no clinical consequence and might benefit from watchful waiting or less aggressive interventions. Care providers endeavor to provide the most appropriate care to patients regardless of cost, but all too often there isn't enough discussion about what is appropriate. Will this test or procedure impact appropriate care and is it in the best interest of the patient? And, further, how can the health care system equip patients to participate in those decisions?

In April 2012, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign, lists of five common procedures or tests whose necessity should be questioned and discussed by patients and their physicians. According to their research, five percent of the U.S. gross national product is spent on tests and procedures that do not improve patient outcomes. The lists, outlined by several specialties, create a structure for patients and physicians to discuss the appropriateness of certain interventions.

Allowing patients the chance to decide for themselves, in consultation with their physician, what procedures and tests best fit their needs can help ensure that resources are used appropriately. In addition, these types of conversations might reduce some of the unnecessary care that may result from increasingly sensitive testing. As recent studies have shown, while the incidence of several cancer diagnoses has increased, there hasn't been a corresponding drop in their mortality, so more people are living with a cancer diagnosis and, more importantly, receiving cancer treatments that may not impact their survival but could reduce their quality of life.

What role can hospitals play in providing a structure for patients and their health care providers to have meaningful conversations about appropriate use of care? Better decision-making leads to higher-quality care and involving patients in their care decisions can improve their satisfaction and lead to improved outcomes. As one of the more intense resource users, hospitals have a responsibility to look for ways to guide appropriate and consistent use of health care and provide tools for health care providers to better communicate with patients around appropriate care. As we navigate from a fee-for-service system to a value-based era, wise use of resources to provide appropriate care is essential.

— John Combes, M.D., is senior vice president, American Hospital Association. Elisa Arespacochaga is director, Physician Leadership Forum, American Hospital Association.


Registration starts for AHA Annual Membership Meeting

Journalists and best-selling authors Bob Woodward and Bob Woodruff, and financial expert and pundit Steve Rattner will be among the prominent keynote speakers at the AHA's 2013 Annual Membership Meeting April 28May 1 in Washington, D.C. The meeting will offer executive briefings on the most pressing issues facing health care leaders, breakout sessions on a variety of topics of interest to hospitals and an opportunity to earn ACHE credits. Visit

HRET wins contracts to boost surgical, primary care quality

The AHA's Health Research & Educational Trust will help implement a national surgical safety program and develop training to strengthen primary care teamwork under two contracts awarded by the Agency for Healthcare Research and Quality. The first project will implement a proven surgical safety checklist, and adapt and implement cultural changes to improve ambulatory surgery safety. The second will develop a training kit for implementing Team Strategies and Tools to Enhance Performance and Patient Safety in the primary care setting based on the recently developed TeamSTEPPS primary care office module. "These contracts are further demonstration of the continued work and success of HRET and AHA to advance patient care and promote best care practices," says Maulik Joshi, HRET president and AHA senior vice president for research.

Tune in to what's up in D.C.

AHA members can stay up-to-date on the legislative and regulatory fronts in Washington, D.C., by tuning in to the Town Hall webcasts once or twice every month. A replay option lets executives use the webcasts in board and staff meetings. All participants must register for the 2013 webcasts, even if they've registered in the past. The next two webcasts are scheduled for Feb. 13 and Feb. 26. Visit