And I am left to imagine where those efforts could go. This could be a tough one for some struggling organizations, because apart from bundled or global payment arrangements or accountable care contracts, saying "no" to acute setting tests and procedures will impact a hospital's bottom line.
Wolfson recalls that when he had a detached retina requiring surgical repair, he was told that he couldn't have the procedure without first having an EKG test. "When I questioned that, they said to me that the anesthesiologist required it because it was protocol. It was department system policy. That's an example of many policies that suggest it's a system change that needs to occur," he says.
Hospitals can tackle policies and procedures that require extra or more frequent imaging without any medical necessity. Wolfson says that Cedars Sinai Medical Center in Los Angeles has embedded 120 decision support points into its electronic medical record system.
Hospitals can institute more "hard stops," such as those being launched at many hospitals to reduce medically unnecessary, elective C-sections and inductions prior to 39 weeks of pregnancy, no matter the physician or patient's request.
There could be hard stops that prompt panel reviews of procedures for some cardiology conditions which have not reached clinically significant thresholds.
And these decision support points can trigger reviews of physician staff privileges, pointing out outliers who may appear to be doing too many procedures.
I eagerly await what the AHA will roll out for its own Choosing Wisely version of this effort.