After considerable debate, the ACEP Council voted this month to refrain from participation in the national “Choosing Wisely” campaign in large part due to the other efforts being taken by ACEP to achieve the same and even larger goals.

“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources, according to its website. As part of the campaign, specialty organizations identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.

ACEP considered joining this campaign three distinct times since its launch in December 2011. Three different workgroups of various ACEP members, committees and Board members looked at the campaign and decided that while the concept is positive, the scope of listed tests, especially for emergency physicians, was too narrow. Despite this extensive review by ACEP members, a resolution was submitted by the New York Chapter asking Council to decide if ACEP should join the “Choosing Wisely” campaign.

As part of the Council process, resolutions are first debated in a reference committee where Council members provide background about the resolution, testify to its merit or explain reasons why it should not be adopted. It was standing room only for the debate and discussion was spirited. The debate continued the next day with many of the same reasons echoed on the open floor of the Council with all 336 voting members in attendance.

Those in support of ACEP joining the campaign said that 26 medical specialties (except for emergency medicine and anesthesia) have joined or committed to participate. They added that participating could give ACEP more national visibility and bargaining power, and that ACEP could use its participation to educate other specialties about emergency medicine’s particular challenges.

Those opposed to ACEP joining the campaign said that the Choosing Wisely campaign does not involve any negotiation with others in medicine, and that it could lead to unintended consequences, including a lack of liability protection, vulnerability to the False Claims Act, and automatic payment denials from insurance companies based on tests that the campaign deems to be “unnecessary.”

One large concern was that the intent of the campaign had already eroded, with several specialties offering only minimal savings and stepping outside of their field and including tests on their lists that are outside the scope of their practice. The issue generated strong feeling on both sides and the majority of the Council decided to refrain from participation.