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Circling the Dome

(Not) Put to the Test

As America takes a more cost-conscious approach to health care, government reforms are driving a shift from volume- to value-based reimbursements. These new mandates are in sync with efforts underway at Johns Hopkins Medicine to eliminate unnecessary tests and procedures.

Particularly exciting is how educators are making these efforts part of the curriculum, says radiologist Pamela Johnson, who directs the High-Value Practice Alliance, an interdisciplinary council focusing on high-value research and health care initiatives at Johns Hopkins.

“The future of medicine rests on our trainees,” says Johnson, who is also director of the Diagnostic Radiology Residency Program. “The best way to teach our students and residents is to mentor them in interventions that improve care.”

The alliance recently launched a new High-Value Health Care website, “which reaches practitioners outside the institution to share Hopkins expertise,” says Johnson. “By [highlighting] our own clinical initiatives, educational materials and research findings, we aim to provide them with the data they need to refine their practice.” 

The website includes One Minute Guides from the Department of Medicine’s High-Value Care Committee. These guides address such questions as, “Should I routinely obtain a urine culture from my asymptomatic inpatients?” or, “Should I routinely test folate levels in anemic patients?” Inspired by the Choosing Wisely program launched in 2012 by the American Board of Internal Medicine Foundation, the easy-to-use literature summaries support recommendations to not order various tests or procedures.

Johns Hopkins was slated to host its first High-Value Practice Research Symposium on Feb. 1, 2016. More than 50 abstracts describing Johns Hopkins initiatives were to be presented, “to share the progress that has been made across the institution,” says Johnson.

For example, radiology last year targeted patients sent for a combined upper GI/small bowel follow-through fluoroscopy study. “Although patients often don’t need both exams, many doctors order both studies,” says Johnson. “Residents called the ordering physicians for six months to discuss each case,” she says. “In close to 30 percent of cases, we were able to eliminate one of the tests, reducing cost, radiation exposure and patient discomfort from lying on the fluoroscopy table for an extended period of time.”

She continues, “It’s important to recognize that these tests often cause patient anxiety and discomfort, and improving the patient experience is an equally critical goal of our quality improvement mission.”