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ASSOCIATED PRESS

Horses and mules pull carts, and horseback riders march Monday during The Tater Day parade on Monday inBenton.

WASHINGTON (AP) —Old checklist for doctors:order that test, write thatprescription. New check-list for doctors: first askyourself if the patient re-ally needs it.

Nine medical societiesrepresenting nearly 375,000physicians are challengingthe widely held perceptionthat more health care isbetter, releasing lists todayof tests and treatmentstheir members should nolonger automatically order.

The 45 items listed in-clude most repeat colono-scopies within 10 years of afirst such test, early imag-ing for most back pain,brain scans for patientswho fainted but didn’t haveseizures, and antibioticsfor mild- to-moderate sinusdistress.

Also on the list: heart im-aging stress tests for pa-tients without coronarysymptoms. And a particu-larly sobering recommen-dation calls for cancerdoctors to stop treating tu-mors in end-stage patientswho have not responded tomultiple therapies and areineligible for experimentaltreatments.

Dr. Christine Cassel,president of the AmericanBoard of Internal Medi-cine, said the goal is to re-duce wasteful spendingwithout harming patients.She suggested some maybenefit by avoiding knownrisks associated with med-ical tests, such as exposureto radiation.

“We all know there isoveruse and waste in thesystem, so let’s have thedoctors take responsibilityfor that and look at thethings that are overused,”said Cassel. “We’re doingthis because we think wedon’t need to ration healthcare if we get rid of waste.”Her group sets standardsand oversees board certifi-cation for many medicalspecialties.

The recommendationscome at a time when Amer-ican health care is under-going far-reachingchanges. No matter whatthe Supreme Court decideson President BarackObama’s health overhaul,employers, lawmakers, in-surers and many doctorsare questioning how theUnited States spends farmore on medical care thanany other economically ad-vanced country and stillproduces mediocre resultsoverall.

Until now, the health caresystem has rewarded doc-tors for volume. Now thefocus is shifting to payingfor results and coordina-tion. That explains the ur-gency for doctorsthemselves to identifyareas of questionablespending.

It’s unclear how muchmoney would be saved ifdoctors followed the 45 rec-ommendations rigorously.Probably tens of billions ofdollars, and maybe hun-dreds of billions over time.That would help, but comenowhere near solving, theproblem of high healthcare costs.

The nation’s medical billhit $2.6 trillion in 2010. Amajor quandary for cost-cutters is that most of thespending is attributable toa relatively small share ofvery sick people. Just 5 per-cent of patients accountedfor half the total costsamong privately insuredpeople, according to a re-cent study from the IMS In-stitute for HealthcareInformatics.

Dr. James Fasules of theAmerican College of Car-diology said the goal is tobegin changing attitudesamong patients and doc-tors.

“We kind of have a gen-eral feeling that if youdon’t get a test, you haven’tbeen cared for well,” saidFasules. “That has perme-ated American culturenow.” The new advice isn’tmeant to override a doc-tor’s judgment, Fasulesadded, but to inform andsupport decisions.

The recommendationswill be circulated to con-sumers and doctors by acoalition calling itselfChoosing Wisely, which in-cludes employer groups,unions, AARP and Con-sumer Reports. Neither theinsurance industry nor thefederal government was in-volved in process.

Each of the nine medicalsocieties submitted fivetests or treatments theyviewed as overused. Theirwork was coordinated by afoundation that’s an off-shoot of Cassel’s group.Eight other medical soci-eties are developing addi-tional recommendations,Cassel said.

The medical societiesdon’t have any power of en-forcement, and fear of mal-practice lawsuits may wellprompt many doctors tokeep ordering as manytests as ever.

Insurers will certainlytake a close look at the rec-ommendations, but whatthey do may be limited.That’s because most of thequestionable tests andtreatments in the lists don’tparticularly stand out inthe avalanche of billsprocessed daily by insur-ance companies.

Take a recommendationfor no annual EKGs for low-risk patients with no heartsymptoms. Dr. John Santa,director of the ConsumerReports Health RatingsCenter, said he used to rou-tinely order EKG’s when hewas a general adult medi-cine practitioner. EKGscost $50 to $60. A medicalassistant would do thetests, and it would takeSanta just a couple of min-utes to read them. Yet 2 per-cent to 3 percent of hisincome came from EKGs,enough to make a differ-ence in a tight year.

“It’s very difficult for aninsurance company to tellthe difference when anEKG is being used as a di-agnostic tool and when it isbeing used as a screeningtest,” said Santa. “It wouldprobably cause more trou-ble for insurance compa-nies.”

New effort by MDs to cutwasteful medical spending

DETROIT (AP) — Appealing smallcars, low interest rates, truck deals andunseasonably warm weather helpedthe auto industry achieve its bestmonthly performance in almost fouryears in March.

General Motors Co. said Tuesdaythat its U.S. sales rose 12 percent com-pared with last March on solid demandfor cars and small crossovers thatachieve 30 miles per gallon or better onthe highway. Chrysler Group’s salesjumped 34 percent as buyers went forFiat small cars and Chrysler sedans.

Toyota Motor Corp. said sales wereup 15 percent, with sales of the Priushybrid climbing 54 percent for themonth. Sales at Ford Motor Co. rose 5percent as demand for the Focus smallcar rose sharply.

Americans who couldn’t bear a newpayment and kept driving their old carduring the economic downturn areback on the market. With gas above $4in some parts of the U.S., buyers areleaning toward new fuel-efficient com-pacts like the Chevrolet Cruze and sub-compacts such as the Honda Fit to savemoney. Also, incentives on trucks aregood enough to lure buyers who wantsomething bigger. Ford said sales ofthe F-Series pickup, the nation’s best-selling vehicle, rose 9 percent.

The consulting firm LMC Automo-tive has predicted U.S. sales of new carsand trucks reached 1.37 million last

month, up 6 percent from March of2011 and the highest number since Mayof 2008. Industry analysts say salescould run at an annual rate of 14.1 mil-lion to 14.5 million vehicles, continuingthe strong performance in January andFebruary.

GM said compact and subcompactcar sales were up a combined 62 per-cent thanks to the new Chevrolet Sonicsubcompact. GM sold 8,251 Sonics inMarch. Sales of the Chevrolet Cruzesmall car were up 20 percent.

Ford said it had its best March since2007. Focus sales were up 65 percentcompared to last March. But that cameat a price. Sales of the Fiesta subcom-pact fell 34 percent as buyers flocked tothe newer and bigger Focus.

For Chrysler, it was the best monthfor the company in four years. Chryslersays Fiat sales hit 3,712, compared tojust 500 last March when the Fiat 500subcompact was first on the market.The Fiat 500 is growing in popularity asnew dealerships open and fuel pricesrise.

Sales of Chrysler’s 200 and 300sedans each doubled over last March.Both cars have recently been revampedand have better fuel economy than pre-vious models, which is attracting newbuyers. Jeep brand sales rose 36 per-cent on the strength of the Jeep GrandCherokee.

Auto sales surge in March, led by small cars, low interest

Tater Days