$1 Trillion Wasted: Unnecessary Procedures and Trimming Fat

By AAPL Staff
May 21, 2018

Although there’s no definitive list of the top money wasters, there are a few areas physician leaders should hold their teams accountable.


Nearly one-third of the United States’ $3.2 trillion in annual health care spending is chalked up as waste, according to the National Academy of Medicine. Practices and treatments once considered routine are now seen as overused, unnecessary and costly.

There’s no definitive list of the top money-wasters.  However, Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, offers a few areas where physician leaders should hold their teams accountable:

Imaging: Avoid for low-back pain within the first six weeks, unless red flags are present.

Vitamin D testing: Avoid ordering routinely in otherwise-healthy children.

Repetitive CBC and labs: Order only in response to specific clinical questions.

Inpatient blood use: No need to routinely transfuse stable, asymptomatic, hospitalized patients with hemoglobin levels greater than 7 to 8 grams.

Pap tests: Annual cervical cytology screening not recommended for women 30 to 65 years of age.

Benzodiazepines: Avoid these and sedative-hypnotics in adults 65 and older as first choice for insomnia, agitation or delirium.

Preoperative testing: Skip EKGs for preoperative/perioperative assessment of patients with no history or symptoms of heart disease.

Telemetry: Continuous monitoring outside of ICU usually isn’t necessary without specific protocols.

Antibiotics: Discontinue after 72 hours for hospitalized patients without clear evidence of infection.

DEXA scans: Typically, not needed more than once every two years.

Topics: Management Journal

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