Editorial: Selective medical tests make sense

If health care spending is ever going to be reined in, it's essential that the public rethink the notion that more care is always better care. So it's remarkably good news that nine medical specialty boards confronted the nation's most critical health care challenge -- controlling costs without compromising care -- by recommending yesterday that doctors perform 45 common tests and procedures less often.

The "choosing wisely" initiative they unveiled is sure to be controversial. But unnecessary tests, treatments and hospitalizations, together with futile care delivered at the end of life, are estimated to account for up to a third of the nation's $2.6 trillion in annual medical spending. That inflated tab undermines the nation's competitiveness and swells federal budget deficits.

What the specialty boards -- including the American Board of Internal Medicine, American College of Cardiology and the American Society of Clinical Oncologists -- have done is identify tests and procedures that add costs while doing nothing to improve patient outcomes; some may actually harm patients. They advised against such practices as including electrocardiograms in routine physicals, doing MRIs whenever a patient complains of back pain or CT scans when a patient faints but has no other neurological symptoms. Oncologists are even advised to do fewer scans on patients with early stage breast and prostate cancers.

Doctors will, and should, continue to assess the particular needs of individual patients and do what's best to treat them. But when considering tests the medical boards identified, the default position should be to forgo them, rather than to do them routinely. The nine boards that participated in yesterday's announcement will be joined soon by eight others that will add more procedures to the list.

With this push to do less coming from doctors rather than the government, charges that it's a calculated bid to save money by rationing needed care will be a lot less persuasive. Hysterical allegations that death panels composed of heartless bureaucrats are out to kill grandma will have absolutely no credibility.

And because the conclusion that the procedures do nothing to improve medical outcomes was reached by recognized specialty boards, the initiative should change accepted standards of care. That will help doctors who forgo the procedures fend off or win malpractice lawsuits in which patients allege they didn't do enough.

There will be a backlash. There was in 2009 when the U.S. Preventive Services Task Force issued new guidelines for mammograms calling for women to be screened less often. And this time the issue isn't just preventive screenings. It takes time for people to accept change, especially in something as personal and important as medical treatment. But the United States currently spends about 18 percent of our national output on health care. That's more, proportionally, than any other advanced nation, but without better results to show for it. And the tab is increasing every year. That has to change.

Wringing out spending that does nothing to improve our health is the obvious place to start.