In January 2010, Dr. Howard Brody, MD, PHD wrote an article, Medicine's Ethical Responsibility for Health Care Reform — The Top Five List. He prescribes taking the top 5 tests and treatments that are the most expensive and commonly ordered for each specialty and creating universal guidelines(developed by clinical epidemiology, biostatistics, health policy, and evidence-based appraisal) . Once these guidelines were agreed upon by each specialty, there would be an implementation of that particular specialty to discourage the use of these tests, etc. by their members to help lower health care costs.
This solicited many responses from physicians across the country. Some physicians said, "yeah, this a great idea" and some commented, "you have got to be crazy". Someone described it as "Utopia".
Correct me if I am wrong, but is that not what RBMs claim they are doing? RBMs state their guidelines are based on the American College of Radiology, physician specialties, clinical practice and research. Of course, there is debate among some (ACR, for one) that they are actually using evidence-based guidelines but they are not as transparent as some would wish them to be.
I agree with Dr. Brody. I believe specialty societies should take the lead. They should be the ones creating evidence-based guidelines, implementing a system to support those guidelines and supporting their members when they use them.
I also believe in tort reform. Physicians should not be punished for using those guidelines and they need someone to cover their backs.
Unfortunately, as it stands now, physicians are at the scrutiny of health insurance companies and RBMs for most tests and procedures they order. If specialty societies would take a more proactive stance when it comes to evidence-based guidelines for all tests and procedures, it would show they actually care about being a part of health care reform. They are the ones best suited for the job not the government, health insurance companies or RBMs.