Stewardship was one of five core values at Mercy Healthcare Systems long before Choosing Wisely® was launched. But according to Dr. Dominic Meldi, a Mercy internal medicine physician and the medical director for care management, the campaign provided a critical boost to Mercy’s effort to avoid the risk, work and cost associated with unnecessary care.
“We all know that a lot of what we do isn’t effective and costs a lot,” Meldi said. “But it’s difficult for any one person to push for change. Choosing Wisely gave credibility to the idea that we need to steward resources.”
Headquartered in Chesterfield, Missouri, Mercy encompasses 32 hospitals and 300 outpatient locations over seven states, making it the nation’s sixth-largest Catholic health system. Recognizing the significance of the recommendations of the specialty societies, Mercy implemented changes system-wide, and encouraged its 1,900 employed physicians to re-examine their individual practice.
After the first Choosing Wisely lists were released in 2012, a group of Mercy medical directors reviewed the 45 recommendations against claims data documenting significant usage. From this analysis, they selected about 25 of the discouraged tests and treatments to target. Physician leaders discussed the recommendations in meetings with large physician sections, such as internal medicine and family practice at one of its largest integrated facilities in Springfield, and found significant enthusiasm to promote the recommendations to co-workers and other physicians.
Although, Mercy discovered significant variation among sites in physicians’ familiarity with Choosing Wisely as the implementation effort expanded to additional clinical locations throughout the system, Dr. Meldi reports that additional educational efforts have led to a broad embrace of the campaign. As Choosing Wisely has grown, Mercy’s effort has grown with it; guiding physicians to incorporate many of the recommendations as practice standards. Individual Mercy physicians have embraced the Choosing Wisely campaign and have implemented some of the recommendations in their practice. The physicians choose a few tests and treatments as particular points of focus to monitor their success in reducing overuse.
Mercy is developing system-wide measures to determine what financial impact the recommendations have had. Yet Dr. Meldi pointed to the fact that many of the recommendations include exceptions that can make measurement challenging. Under the leadership of Dr. John Zalewski at its St. Louis location, Mercy generated individualized reports for its physicians showing how often they ordered imaging for patients who presented with headaches, and shared the reports with them in the hope of reducing variation.
Lastly, Mercy also embraced Choosing Wisely as an employer concerned about the rising costs of care for its 39,000 employees. Its employee newsletter features a regular section that focuses on Choosing Wisely recommendations related to treatment for common conditions like low back pain and sinusitis, and encouraged employees to have conversations with their physicians about the necessity of particular tests and treatments.