Is there any doubt that cost containment is the top priority for health care providers today? Name an issue, any issue, and you can draw a straight line back to cost containment. There's no need to play six degrees of separation. To be sure, things like meaningful use, population health and other issues are multifaceted and will have wide-ranging impact, but they are also aimed squarely at reining in the cost of health care. As if you didn't already know this, right?

Well, I was struck by the fact that, in the past two weeks, trade groups representing both hospitals and physicians released significant documents shining a bright light on cost containment. Yesterday, nine medical specialty boards released a list of 45 tests and procedures that they say are "commonly used but not always necessary." The list includes such things as:

  • "Don't do imaging for low back pain within the first six weeks, unless red flags are present."
  • "Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam."
  • "Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals."
  • "Don't use cancer-directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anti-cancer treatment."

Now, the physician groups, which have organized under the banner Choosing Wisely, know that they'll take some heat and be accused of trying to ration care. But the physicians also know that a significant amount health care spending — as much as one-third by some estimates — can be trimmed from the system by doing away with unnecessary tests and procedures. It's not rationing care, it is rational care.

"Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed," Christine K. Cassel, M.D., president and CEO of the ABIM Foundation, stated. "Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care."

A week earlier, the AHA's Health Research and Educational Trust, in partnership with Kaufman Hall, put out an insightful guide on how hospitals can focus their energies on cost containment and transforming operations. As the guide notes, with health care moving to a value-based system, payments will be constrained. "To continue meeting community health care needs in this new delivery and payment environment, hospital and health system leaders will need to think and act strategically about managing costs. Strategic cost transformation will be required."

The guide goes on to detail two parts of a three-pronged approach: reducing costs of current operations and reducing costs by restructuring businesses and service lines. In this latter category, the guide says hospital leaders must assess which areas are core to their mission going forward. And, "Where can we most effectively invest our limited and human resources to meet the continuing health needs in our communities?" In other words, hospitals and health systems can't continue to be all things for all people. Much like the docs in Choosing Wisely suggest, some hard decisions need to be made.

Here at H&HN, we embarked on a yearlong journey last October to detail how hospitals and health systems are working to hold the line on costs while focusing on delivering high value care. Our Fiscal Fitness series has looked at hospitals deploying Lean, Six Sigma and other performance improvement techniques, and has drilled down into such specific areas as clinical efficiency, staffing and energy.

We'll continue to explore cost containment in the coming months and welcome your stories. Feel free to contact me at