New📜- Commercially-insured adults w/ acute uncomplicated low back pain who receive low-value imaging (vs don’t) are 9-14%points more likely to get cascade services and they pay up to $500 more OUT-OF-POCKET in the following months. 🧵👇🏾rdcu.be/cWCIO For patients with simple low back pain, getting an early X-Ray or MRI can be tempting. But these tests are almost always unhelpful + can trigger cascades of downstream services w/ minimal potential for benefit + potential for $/other harms.

New @JAMAInternalMed w/ @DKorenstein: #ChoosingWisely has had huge reach in shaping conversations - and efforts to reduce - #lowvaluecare. We unpacked the types and expected impact of U.S. #ChoosingWisely recommendations, w/ some surprising finds. 🧵1/ jamanetwork.com/journals/jamai… In 2012, @ABIMFoundation @ConsumerReports launched #ChoosingWisely - asking professional societies to list low-value services to avoid. CW intentionally let docs set their own priorities to leverage their professional values, but some worried about unintended consequences. 2/

How common are “cascades” after incidental findings? In @JAMANetworkOpen we present our survey of US generalists (n=376 completed,RR 45%). Most had experienced cascades w/ no clinically impt outcomes yet caused harms to patients and themselves. THREAD(1/9) bit.ly/33BS7WM 99% of doctors experienced cascades, most frequently including phone calls with patients, repeated tests. Most had experienced a cascade leading to an invasive test, ED visit, or hospitalization. (2/9) w/ @greyscalespaces @TomSequist @AJMainor @CHColla @ClaireLupo @ACPinternists