Health care accounts for a large, and escalating, proportion of the gross domestic product, yet the overall value of many of these expenditures is unclear. The Institute of Medicine estimates that $750 billion could be saved annually by reducing health care inefficiencies, including $210 billion by eliminating unnecessary services.1 A recent attempt to reduce these unnecessary services, the Choosing Wisely campaign aims to stimulate a conversation between physicians and patients about the necessity of tests, procedures, and medications. The initial Choosing Wisely lists, including 1 from the American Academy of Neurology (AAN),2 represent an essential first step in the reduction of waste. Moving forward, physicians can choose even more wisely. To do so requires a framework for the complex task of prioritizing waste reduction targets out of the innumerable combination of tests, procedures, and medications.
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