As the population ages, and more people receive health coverage through Medicare, "we don't want people to be getting fewer knee replacements. We're going to have more people aging, and they are going to have heart attacks and strokes and heart valve surgery."
She suggests that one way to do that might be through payment models such as bundling of episodes of care and accountable care organizations.
"If you're bundling care for, say, valve surgery, and a hospital knows it will get $25,000 for that surgery, they're going to try to find a way to drop the cost so they get a margin on it. And that's pressure on them to reengineer specific items of care.
"Hospitals are going to start innovating how they're going to streamline and improve their processes of care to make it less expensive. And the same goes for knee and hip replacement, where the prices for these things have gone way, way up, but it's not totally clear that the quality is any better."
True, she acknowledges, some patients receive unnecessary care, such as surgery that may be no more effective than medical management with physical therapy. The Choosing Wisely campaign attempts to make patients think carefully about whether a particular procedure will accomplish their treatment goals, weighing the potential for adverse consequences and harm.