The Choosing Wisely campaign to decrease unnecessary imaging launched in April 2012 and has had an impact in some regions of the country, but not the regions that needed it most, according to an article in Health Affairs.
The American Board of Internal Medicine launched the Choosing Wisely campaign in 2012 to reduce "low value" medical services; one facet of the campaign specifically targets imaging for low back pain. The study authors examined data from 2010 to 2014, covering the years before the campaign and after.
The low back pain imaging comes at a high out-of-pocket expense for patients and is ordered at a high volume across the country.
The study authors examined Optum data covering 29 million commercially insured patients across the country. Researchers differentiated low value and high value imaging visits based on the patient's diagnosis. There were 1.5 million patients who underwent 1.8 million visits without a "red flag" diagnosis in the study period; an additional 408,192 patients with a "red flag" diagnosis underwent 460,663 visits during the study period.
The researchers found:
1. Less than 1 percent — 0.4 percent — of the low-value images occurred seven days before the initial visit; 54.8 percent occurred on the same day as that visit and 44.8 percent occurred within the first six weeks after the initial visit. Eighty-eight percent of the low-value imaging occurred within three weeks of the initial visit.
2. Among the low value visits, 75.9 percent were X-rays while the remaining were CT or MRI scans.
3. Low value back imaging dropped 3.81 percent when compared to the predicted pre-Choosing Wisely trend, hitting 22.07 percent. At the same time, high value imaging remained relatively similar from 2010 to 2014, hitting 37.22 percent.
4. The South had the highest rate of low value imaging in 2010 and reported the smallest relative reduction in low value imaging by the end of the study period, a 2.45 percent reduction. The Northeast region of the country reported the largest reduction after Choosing Wisely, a 7.79 percent drop.
5. The low value imaging rate among consumer-directed health plan members was 4.76 percent by the end of the study, lower than the predictions based on the baseline trend; nonmembers reported a 4.02 percent reduction.
"Our analysis suggests Choosing Wisely recommendations combined with patient-level consumer incentives might be insufficient to reduce low-value medical care," concluded the study authors. "Findings might also suggest that certain provider systems (for example, those in the Northeast) are more responsive than others to recommendations to improve clinical value."