Table 2.

Average annual prevalence of, variation in and spending associated with Choosing Wisely procedures and tests (N = 306 hospital referral regions)

Choosing wisely services*	Mean	Affected population (millions)	Minimum and maximum	Interquartile range	Coefficient of variation	Estimate of waste ($millions)†	Top HRRs
Low-value diagnostic services
Back pain imaging	22.5%	1.9	12.8–32.9%	20.1–25.0%	0.16	$35.6	Bismarck, ND Dubuque, IA Sioux Falls, SD
BPH Imaging	1.2%	0.9	0.2–8.6%	0.6–1.5%	0.82	$0.3	Saginaw, MI New Brunswick, NJ Gainesville, FL
Cardiac screening	12.2%	3.4	6.5–20.6%	10.2–13.8%	0.24	$9.4	Providence, RI Ridgewood, NJ White Plains, NY
Cervical cancer screening	3.1%	14.3	0.4–10.5%	1.6–4.0%	0.71	$7.4	Fort Lauderdale, FL Honolulu, HI East Long Island, NY
DXA Testing	9.7%	13.3	2.6–32.5%	6.5–11.7%	0.45	$16.8	McAllen, TX Provo, UT Harlingen, TX
Preoperative cardiac testing (cataract surgery)	15.4%	1.0	1.2–46.5%	6.8–24.0%	0.66	$0.6	Springfield, MA Worcester, MA Baltimore, MD
Preoperative cardiac testing (non-cardiac surgery)	46.5%	0.3	12.1–75.4%	40.7–52.7%	0.20	$3.2	York, PA Jackson, TN Morgantown, WV
Vitamin D screening	8.8%	20.4	2.2–21.1%	6.5–10.9%	0.37	$198.6	Lynchburg, VA Royal Oak, MI Takoma Park, MD
Low-value treatments
Antipsychotics in dementia patients	31.0%	1.0	19.8–42.3%	28.5–33.1%	0.12	$765.1	Tuscaloosa, AL Monroe, LA Metairie, LA
Feeding Tubes in dementia patients	9.0%	0.3	0.3–34.5%	4.9–11.6%	0.60	$148.9	McAllen, TX Harlingen, TX Los Angeles, CA
Opioids in migraine patients	23.6%	0.1	10.7–46.6%	18.0–28.2%	0.27	$3.3	Texarkana, AR Tuscaloosa, AL Dothan, AL

*“Back Pain Imaging” is the average annual percent of beneficiaries with uncomplicated, incident low-back pain who received non-indicated low-back imaging in the six weeks following diagnosis, 2007–2011. “BPH Imaging in Low-Risk Patients” is the average annual percent of male beneficiaries with benign prostatic hypertrophy (BPH) who received non-indicated upper urinary tract imaging in the 60 days after the index diagnosis, 2006–11. “Cardiac Testing in Low-Risk Patients” is the average annual percent of low-risk beneficiaries who received one or more non-indicated cardiac tests, 2006–11. “Cervical Cancer Screening” is the average annual percent of female beneficiaries who received at least one non-indicated screening test for cervical cancer, 2006–11. “DXA Testing (short interval)” is the average annual percent of non-indicated dual-energy x-ray absorptiometry (DXA) tests performed within 23 months of a previous DXA test, 2008–11. “Preoperative Cardiac Testing (cataract surgery)” is the average annual percent of beneficiaries undergoing cataract surgery who received one or more non-indicated cardiac tests in the 30 days before surgery, 2006–11. “Preoperative Cardiac Testing (non-cardiac surgery)” is the average annual percent of beneficiaries undergoing low-risk, non-cardiac surgery who received one or more non-indicated cardiac tests in the 30 days before surgery, 2006–11. “Vitamin D Screening” is the average annual percent of beneficiaries who received at least one non-indicated vitamin D screening test, 2006–11. "Antipsychotics in Dementia Patients” is the average annual percent of beneficiaries with diagnosed dementia and without a severe mental illness who received antipsychotic medication, 2006–11. “Feeding Tubes in Dementia Patients” is the average annual percent of beneficiaries with advanced dementia who received a feeding tube, 2006–11. “Opioids in Migraine Patients” is the average annual percent of beneficiaries with a diagnosed migraine who received a non-indicated opioid prescription in the 21 days after an office visit with migraine diagnosis, 2006–11.

† Annual spending estimate represents the total annual allowed amount attributed to utilization of the Choosing Wisely services in 2011. Spending estimates and population amounts are scaled to 100% of the fee-for-service Medicare population