Choosing Wisely After the Pandemic

As hospitals and health systems begin to re-open after shutting down many services in response to COVID-19, leaders at many institutions know that they will not be returning to the pre-coronavirus status quo anytime soon. They face shortages of supplies and testing equipment, and have to retain capacity to treat a potential surge of new COVID patients. They also have to limit crowding to reduce potential exposure of patients and clinicians to the virus. As a result, some hospitals and systems will inevitably prioritize some kinds of care over others.

A group of individuals and organizations that have been involved in Choosing Wisely and other efforts to reduce overuse hopes to persuade system leaders and clinicians to keep their focus on high-value care as they navigate this unprecedented period.

“We must decide what care to pursue,” said Daniel Morgan, MD, the initiator of the idea to convene organizations focused on high and low value care, the Chief Hospital Epidemiologist at the VA Maryland Healthcare System, and a professor at the University of Maryland School of Medicine. “Do we just restart providing health care as we did before or do we choose to maximize the value we can provide and to provide the most important care?”

The initiative is in its early stages, but its goals are for health care systems to prioritize the most meaningful and highest value care in their reopening, and for clinicians and patients to determine individual priorities for providing and receiving care. To aid in achieving that goal, initiative participants plan to develop an evidence-based framework for the patient-centered reopening of health systems, and materials that can help systems and clinicians prioritize care. They also intend to create a network for clinicians and system leaders to share experiences and learn from one another.

A number of organizations and individuals are helping develop the initiative, including AcademyHealth, the Institute for Healthcare Improvement, the ABIM Foundation, Costs of Care, the High Value Practice Academic Alliance, the National Alliance of ACOs, patient representatives, and clinicians at the VA, Memorial Sloan Kettering, and elsewhere.

The initiative’s developers recognize that some hospitals and systems are facing significant financial difficulties because of the pandemic, but believe that an effort to prioritize the highest-value care will not undermine their financial health.

“We should keep finances a consideration—but not let it drive the health care endeavor,” Dr. Morgan said. “There are enough high-value parts of care to prioritize those that do pay well.”

Of course, many patients are also facing unprecedented financial pressures due to the recession sparked by COVID-19. The initiative seeks to respond to the current economic climate.

“What could be new during this time of decreased capacity is reducing marginal care that has little benefit to patients,” Dr. Morgan said. “If patients can avoid the expense of marginal care, they can be better prepared to spend money elsewhere.”

Dr. Morgan said that the initiative’s participants were not looking to “tell clinicians exactly what to prioritize.” He said, however, that he did think that this re-opening presented an opportunity to help clinicians better distinguish between care that is “really important” and care that is “marginal.”

Individuals or organizations that are interested in joining this initiative should contact Dr. Morgan at dmorgan@som.umaryland.edu.