Studies have shown that doctors continue to order or perform unwarranted imaging tests for low back pain, cervical cancer screenings, colonoscopies, knee arthroscopies, CT scans in the emergency department and pre-operative stress tests even though evidence indicates they don't help patients, may generate false positives and could put patients at risk, Graman said.
“This is a stubborn problem and it's our problem to solve,” he said. “We need to do more education and less appeasement of our patients.”
In his own practice, he said, he has developed such a good reputation for avoiding unnecessary prescribing that patients thank him for not ordering antibiotics for their upper-respiratory infections.
There are often multiple guidelines for similar conditions and, according to Graman, medical groups may get frustrated and decide not to follow any of them. Instead, Graman said—when there are multiple sets of guidelines—providers should choose one, follow it, monitor it and reward adherence.
He recommended making guideline adherence rewards part of a group's standard physician-compensation package, even though many doctors bristle at guidelines as “cookbook medicine.”
However, not following medical evidence will be “the fastest way to lose your autonomy,” Graman said.
Donald Fisher, AMGA president and CEO, said the group's 2014 government advocacy efforts will focus on a total repeal and replacement of the Medicare sustainable growth-rate physician payment formula and refinement of accountable care organization legislation and regulation.
The AMGA helped draft the ACO provision in the Patient Protection and Affordable Care, and Fisher described it as “a provision that still dominates the healthcare landscape.”
“I can't imagine a more exciting time to be working in healthcare,” said Fisher, who has led the AMGA since 1980.
Follow Andis Robeznieks on Twitter: @MHARobeznieks