Improving health care in our country requires simultaneous pursuit of 3 aims: improving the effectiveness of care, improving the health of our population, and reducing the per capita costs of health care.1 As our nation focuses on ways to achieve this triple aim, the unwarranted overuse of health care resources is a significant concern. The continuing rise in health care costs, estimated at $2.8 trillion or 17.2% of gross domestic product in 2012, puts financial pressure on our national economy. Consequently, individuals are burdened by rising insurance premiums, deductibles, and copayments, often in addition to lost wage increases due to rising costs of premiums incurred by employers.2 Proponents of the triple aim have suggested there is ample capacity in our current health care system to achieve these goals by reducing unnecessary tests, treatments, and procedures.1 In fact, the Institute of Medicine estimates that in 2009 alone more than $750 billion (or 1 in 3 dollars spent on health care) was spent on unnecessary medical tests, procedures, and missed prevention opportunities.3
Implementing strategies that reduce unnecessary tests and procedures becomes a challenge, particularly when considering that most of these tests and procedures are covered by insurance. The federal government and private payers have attempted to control health care expenditures and utilization by increasing the number and complexity of regulations and requirements that govern the provision of care. Although the intent may be to improve patient care, these frequently changing and increasingly intricate regulations have led to a burdensome practice environment, challenging the ability of clinicians and administrators to remain compliant. Additionally, attempts to control utilization and costs have led to a significant increase in audits and investigations.4 Because of the complexity of the regulatory environment, even the most diligent health care professionals may find themselves the …
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