Selected Podcast
Ep. 8: Avoiding the Unnecessary: Partnering with Patients to Make the Right Healthcare Decisions
Roxanna Gapstur and her guest David Hoffmann discuss WellSpan's Choosing Wisely initiative and how to promote conversations between clinicians and patients in order to choose the right care, at the right time and in the right place.
Featuring:
David Hoffmann, DO, MBA | Roxanna Gapstur, PhD, RN
David (Dave) Hoffmann DO, MBA is the Vice President, Chief Clinical Officer for Wellspan Summit Health. Transcription:
Michael Carrese (Host): Welcome to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. I’m Michael Carrese and Roxanna, good to be with you again.
Roxanna Gapstur PhD, RN (Guest): Great to be with you Michael.
Host: What are we talking about today?
Roxanna: Today, we’re going to be talking about exploring affordability through the lens of lowering healthcare costs. And how we do that is by removing waste from our care delivery system. And so, specifically today, we’ll talk about a focus on choosing wisely and promoting conversations between physicians, clinicians and patients to avoid unnecessary testing.
Host: And you have a special guest with you?
Roxanna: I do, I have Dr. David Hoffmann, Vice President and Chief Clinical Officer for WellSpan’s Summit Health.
Host: Roxanna, affordability is a topic we’ve touched on before in this podcast series. How does removing waste play into affordability?
Roxanna: Yes, it’s really important Michael. One of the things we’ve talked about in the past is we need to choose the right care at the right time and the right place. And so, today, we’ll talk more about those elements of affordability, but when it comes to choosing wisely; part of making the right choice is avoiding overuse of low value or unnecessary healthcare. This is the waste that can be removed. So, overuse of unnecessary medical tests and treatments is a global problem and we all know that. So, those are savings which can be passed on to patients.
Host: Yeah, in fact Dr. Hoffmann, I was reading an article recently which indicated that waste accounts for almost a quarter of all US healthcare spending. It’s something like seven to nine hundred billion dollars annually.
David Hoffmann, DO, MBA (Guest): When you really drill down deeper into that study conducted by the Journal of American Medical Association; research has identified that overtreatment or low value care resulted in almost 75 to 100 billion dollars of waste every year in our country. I think we can all agree that overuse hurts our patients and wastes healthcare resources. This waste drives up the cost for consumers.
Host: So, how is WellSpan going to tackle overuse Roxanna?
Roxanna: So, we’re following the guidance of choosing wisely which is a clinician lead campaign to advance a national dialogue between clinicians and patients. Helping patients choose care that’s supported by evidence and it’s not duplicative of healthcare they’ve already received. This also helps mean that it’s free from harm and it’s truly necessary. So, since its inception; the organization has released a set of evidence based recommendations as a priority in limiting overuse of tests and procedures in healthcare settings around the world. They’ve advocated for the elimination of prescribing antibiotics in patients with upper respiratory infections, avoiding imaging for nonspecific lower back pain and uncomplicated or stable headaches, eliminating vitamin D testing and routine annual cervical cytology screening or PAP tests. So, many of these recommendations we’ve adopted at WellSpan and I’m really proud of the organization because our resource utilization is lower than many others in our region.
It means our system wide utilization committees which scrutinize some of our practice habits are successfully assisting our physicians with choosing wisely when ordering pharmaceuticals, lab testing, imaging studies and new technologies.
Host: And choosing wisely isn’t just about the physicians making the best choices is it Dave?
Dr. Hoffmann: No, the foundation of making good choices in healthcare is the belief that doctors, and care teams are partners with our patients. Not the we’re just the decision makers. And that’s really what we believe at WellSpan Health. In fact, we’ve adopted a new vision which puts this front and center, a trusted partner, reimagining healthcare, inspiring health. I’ve listening to this podcast and I know you’ve talked about this new, big, bold, vision and actually, I’m really very proud to be part of this organization that values partnerships so, thank you Roxanna for leading this effort.
Roxanna: Absolutely. A partnership is certainly where it’s at with patients and families. We want the best care for our patients and to do that, we need to include their information and their perspectives as well.
Host: And how does that play out in your interactions with patients as a physician?
Dr. Hoffmann: So, we’ve been relentlessly pursuing an internal Know Me initiative over the last couple of years, really making an effort to get to know our patients, their health histories, their social environments, their mental health status. And we’re advancing a culture of encouraging our patients to ask more questions. I still have the opportunity to see patients myself as a hospitalist and my goal is to never let a patient leave the hospital feeling confused about next steps or unsure about what to expect. My goal is to really meet the patient where they are at and to explain things in terms that they can relate to. This last weekend, I was doing a shift at Waynesborough Hospital and I was asked to evaluate a patient with chest pain in the emergency room. I saw a patient who was a 40-year-old female, I was asked to admit for chest pain in the emergency room. After examining her and looking at her labs and tests; we concluded she was a low risk patient and when I explained to her that she had only a one in a hundred chance of having a cardiac event in the next 30 days; I gave her the option to either be really safe and stay in the hospital overnight or go home and follow up with her family doctor in the next week. She chose to go home, and I think she was very comfortable with that decision and in fact, she had a high deductible plan and that saved her a lot of dollars.
Host: So, right and along the lines of getting patients involved in this conversation; there’s a public service announcement that Choosing Wisely, that organization that Roxanna referred to before has – let’s all take a listen to that and see what kinds of questions we’re hoping patients will ask.
Announcer: You’ve got a doctor’s appointment and they recommend a test, treatment or procedure but is it really necessary for you? To find out the Choosing Wisely Campaign suggests that you ask your doctor what the risks are, if there are other options and what happens if you don’t do anything? Asking these questions can help make sure you get the right care at the right time. To learn more about Choosing Wisely visit www.choosingwisely.org.
Host: So, Dr. Hoffmann why don’t you react to that first. Do I need this, what are the risks and so forth. What do you think of those questions?
Dr. Hoffmann: We know today that patients are more sophisticated and have a wealth of information to be accessed. The downside is there’s a lot of misinformation out there. And that’s why we’re trying to build trust and collaborating with our patients and that’s why it’s very crucial.
Host: And what do you do when patients are feeling like I really want to have you do something? They want you to take some kind of action and if the message is you know, we really don’t need to do this. you really are not in that category of needing this. How do you have that conversation?
Dr. Hoffmann: I think it’s important to review the data, their risks and then the positive and negative effects. I mean every treatment, every medicine that we give can affect the patient both positively and negatively. For example, antibiotics when somebody gets an upper respiratory infection. So, I really think that in today’s world, we need to get with our patients, explain the risks and benefits and have a real heart to heart conversation where they have information so they can make better choices. It’s not necessarily us physicians choosing for them but working in partnership together.
Host: Yeah, having that dialogue. So, as we wrap up here, Roxanna what do you want WellSpan employees to take away from the conversation?
Roxanna: WellSpan employees are healthcare consumers too and so we should model the way by asking questions ourselves. The more we can advance that culture of dialogue and openness; the more we’ll be valued as a trusted partner. I think it’s really important for our physicians and APCs to be in the know about the Choosing Wisely Campaign and it’s recommendations to decrease overuse of unnecessary tests, treatments and procedures. And we can all find out more about it at www.choosingwisely.org.
Host: I’m afraid we’ll have to leave it there. Interesting conversation today. you’ve been listening to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. Roxanna’s guest today has been Dr. David Hoffmann. Thanks for joining us.
Michael Carrese (Host): Welcome to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. I’m Michael Carrese and Roxanna, good to be with you again.
Roxanna Gapstur PhD, RN (Guest): Great to be with you Michael.
Host: What are we talking about today?
Roxanna: Today, we’re going to be talking about exploring affordability through the lens of lowering healthcare costs. And how we do that is by removing waste from our care delivery system. And so, specifically today, we’ll talk about a focus on choosing wisely and promoting conversations between physicians, clinicians and patients to avoid unnecessary testing.
Host: And you have a special guest with you?
Roxanna: I do, I have Dr. David Hoffmann, Vice President and Chief Clinical Officer for WellSpan’s Summit Health.
Host: Roxanna, affordability is a topic we’ve touched on before in this podcast series. How does removing waste play into affordability?
Roxanna: Yes, it’s really important Michael. One of the things we’ve talked about in the past is we need to choose the right care at the right time and the right place. And so, today, we’ll talk more about those elements of affordability, but when it comes to choosing wisely; part of making the right choice is avoiding overuse of low value or unnecessary healthcare. This is the waste that can be removed. So, overuse of unnecessary medical tests and treatments is a global problem and we all know that. So, those are savings which can be passed on to patients.
Host: Yeah, in fact Dr. Hoffmann, I was reading an article recently which indicated that waste accounts for almost a quarter of all US healthcare spending. It’s something like seven to nine hundred billion dollars annually.
David Hoffmann, DO, MBA (Guest): When you really drill down deeper into that study conducted by the Journal of American Medical Association; research has identified that overtreatment or low value care resulted in almost 75 to 100 billion dollars of waste every year in our country. I think we can all agree that overuse hurts our patients and wastes healthcare resources. This waste drives up the cost for consumers.
Host: So, how is WellSpan going to tackle overuse Roxanna?
Roxanna: So, we’re following the guidance of choosing wisely which is a clinician lead campaign to advance a national dialogue between clinicians and patients. Helping patients choose care that’s supported by evidence and it’s not duplicative of healthcare they’ve already received. This also helps mean that it’s free from harm and it’s truly necessary. So, since its inception; the organization has released a set of evidence based recommendations as a priority in limiting overuse of tests and procedures in healthcare settings around the world. They’ve advocated for the elimination of prescribing antibiotics in patients with upper respiratory infections, avoiding imaging for nonspecific lower back pain and uncomplicated or stable headaches, eliminating vitamin D testing and routine annual cervical cytology screening or PAP tests. So, many of these recommendations we’ve adopted at WellSpan and I’m really proud of the organization because our resource utilization is lower than many others in our region.
It means our system wide utilization committees which scrutinize some of our practice habits are successfully assisting our physicians with choosing wisely when ordering pharmaceuticals, lab testing, imaging studies and new technologies.
Host: And choosing wisely isn’t just about the physicians making the best choices is it Dave?
Dr. Hoffmann: No, the foundation of making good choices in healthcare is the belief that doctors, and care teams are partners with our patients. Not the we’re just the decision makers. And that’s really what we believe at WellSpan Health. In fact, we’ve adopted a new vision which puts this front and center, a trusted partner, reimagining healthcare, inspiring health. I’ve listening to this podcast and I know you’ve talked about this new, big, bold, vision and actually, I’m really very proud to be part of this organization that values partnerships so, thank you Roxanna for leading this effort.
Roxanna: Absolutely. A partnership is certainly where it’s at with patients and families. We want the best care for our patients and to do that, we need to include their information and their perspectives as well.
Host: And how does that play out in your interactions with patients as a physician?
Dr. Hoffmann: So, we’ve been relentlessly pursuing an internal Know Me initiative over the last couple of years, really making an effort to get to know our patients, their health histories, their social environments, their mental health status. And we’re advancing a culture of encouraging our patients to ask more questions. I still have the opportunity to see patients myself as a hospitalist and my goal is to never let a patient leave the hospital feeling confused about next steps or unsure about what to expect. My goal is to really meet the patient where they are at and to explain things in terms that they can relate to. This last weekend, I was doing a shift at Waynesborough Hospital and I was asked to evaluate a patient with chest pain in the emergency room. I saw a patient who was a 40-year-old female, I was asked to admit for chest pain in the emergency room. After examining her and looking at her labs and tests; we concluded she was a low risk patient and when I explained to her that she had only a one in a hundred chance of having a cardiac event in the next 30 days; I gave her the option to either be really safe and stay in the hospital overnight or go home and follow up with her family doctor in the next week. She chose to go home, and I think she was very comfortable with that decision and in fact, she had a high deductible plan and that saved her a lot of dollars.
Host: So, right and along the lines of getting patients involved in this conversation; there’s a public service announcement that Choosing Wisely, that organization that Roxanna referred to before has – let’s all take a listen to that and see what kinds of questions we’re hoping patients will ask.
Announcer: You’ve got a doctor’s appointment and they recommend a test, treatment or procedure but is it really necessary for you? To find out the Choosing Wisely Campaign suggests that you ask your doctor what the risks are, if there are other options and what happens if you don’t do anything? Asking these questions can help make sure you get the right care at the right time. To learn more about Choosing Wisely visit www.choosingwisely.org.
Host: So, Dr. Hoffmann why don’t you react to that first. Do I need this, what are the risks and so forth. What do you think of those questions?
Dr. Hoffmann: We know today that patients are more sophisticated and have a wealth of information to be accessed. The downside is there’s a lot of misinformation out there. And that’s why we’re trying to build trust and collaborating with our patients and that’s why it’s very crucial.
Host: And what do you do when patients are feeling like I really want to have you do something? They want you to take some kind of action and if the message is you know, we really don’t need to do this. you really are not in that category of needing this. How do you have that conversation?
Dr. Hoffmann: I think it’s important to review the data, their risks and then the positive and negative effects. I mean every treatment, every medicine that we give can affect the patient both positively and negatively. For example, antibiotics when somebody gets an upper respiratory infection. So, I really think that in today’s world, we need to get with our patients, explain the risks and benefits and have a real heart to heart conversation where they have information so they can make better choices. It’s not necessarily us physicians choosing for them but working in partnership together.
Host: Yeah, having that dialogue. So, as we wrap up here, Roxanna what do you want WellSpan employees to take away from the conversation?
Roxanna: WellSpan employees are healthcare consumers too and so we should model the way by asking questions ourselves. The more we can advance that culture of dialogue and openness; the more we’ll be valued as a trusted partner. I think it’s really important for our physicians and APCs to be in the know about the Choosing Wisely Campaign and it’s recommendations to decrease overuse of unnecessary tests, treatments and procedures. And we can all find out more about it at www.choosingwisely.org.
Host: I’m afraid we’ll have to leave it there. Interesting conversation today. you’ve been listening to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. Roxanna’s guest today has been Dr. David Hoffmann. Thanks for joining us.