Update on ACEP and the Choosing Wisely Campaign


ACEP President Dr. David SeabergAlthough ACEP has previously reviewed the Choosing Wisely Campaign and agreed not to participate, due to continued questions and comments from our members, I convened a workgroup to re-review the campaign and ACEP’s participation.  The workgroup consisted of a wide and diverse representation of ACEP members and Committees.

The group was overwhelming in support of not joining the Choosing Wisely Campaign.  Although the issue of cost control is crucial for emergency medicine’s future, the Choosing Wisely Campaign is not the vehicle for ACEP’s participation.

Several important points were made during the workgroup meeting:

  • The College needs to be viewed by CMS, payers, and the public as proactively addressing cost containment and overuse.
     
  • ACEP needs to be seen as proactively providing solutions rather than appearing to be against any cost cutting or savings suggestions.
     
  • The College developing and communicating a plan with proactive proposals/solutions will mitigate some cost cutting measures from those that do not understand the unique position of emergency care. It was noted part of the success of the Washington State initiative was the ability to come to the table with a plan, rather than push back against the plan of action presented by the State.
     
  • Whatever is developed should showcase the specialty in a favorable light and not contradict or conflict with current advocacy efforts.
     
  • There was support for identifying over-use and developing a positive message on cost savings and efficiencies in the emergency department.
     
  • To come to consensus on a certain number of tests or services that have limited use would require so many caveats that it would be almost impossible to develop lists as found in the Choosing Wisely Campaign.
     
  • Ideally any recommendations should include some liability reform/recommendations in using guidelines that may suggest certain tests or procedures are not effective or necessary.
     

It was recommended that ACEP develop a task force from committees, sections, and members with expertise in these areas to develop a proactive campaign that recognizes the role the emergency department and emergency physicians can play in controlling costs while improving efficiencies and quality patient care. 

The process has already begun with the task force being constituted with the goal of developing messages and strategies for cost control in the emergency department.  The task force will make their recommendations at the October ACEP Board of Directors meeting. 
We also will be educating our members about cost savings programs from other specialties, such as the Image Wisely and Image Gently programs from the American College of Radiology.

DAVID SEABERG, MD, FACEP
President, American College of Emergency Physicians

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  1. #1 by DH Newman - June 3rd, 2012 at 15:10

    This is, of course, deeply disappointing to many. Most of the bullet points above appear to be apologies that recognize the importance of Choosing Wisely, rather than explanations for why EM would consider itself exempt or special.

    The elemental question is this: do we want to lead, or follow? If we allow others to choose what constitutes over-utilization in our EDs, we will only follow, and we will lose control of our fate. I am sorry to hear this.

  2. #2 by Jerome Hoffman - August 27th, 2012 at 19:01

    I can only echo David Newman’s thoughtful comment. Most of our membership understands that it is truly wrong for ACEP to take this retrograde position, even in the face of the enormous problems facing our healthcare system. I hope many of us will speak out, and convince our organization not to allow concerns about (presumed) narrow self-interest to keep us from doing what is so obviously the right thing.

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