The National Physicians Alliance Monday published recommendations on how to improve primary care while cutting costs.

The guidelines recommend doctors start heart patients on generic statins rather than brand-name drugs to lower cholesterol, as well as skipping cardiac screenings for healthy patients. They also recommend limiting osteoporosis screening for women under 65 to those who have risk factors, and starting Pap tests for women at age 21.

The recommendations are largely already considered best practices, but Drexel University public health professor Robert Field said it is encouraging that the emphasis on unnecessary tests is coming from a doctors group rather than the government or an HMO.

"I think it is very encouraging that it's the doctors themselves, the people in the trenches, who are looking around and saying 'We're contributing to this cost problem, our colleagues are contributing to this cost problem, we know what's needed and what isn't, and come on guys lets do the right thing,' " Field said.

Still, raising awareness about which tests aren't backed by evidence showing their worth for specific populations is just the beginning.

"If it's your child and you feel the extra antibiotic or the extra test might be helpful and it doesn't cost anything, well, why not go ahead and ask the doctor to do it?" Field said. "I think what we really need to do is get at the financial incentives."

Field said until co-payments and deductibles show patients the true cost of unnecessary tests, change might be slow in health care, where many think more care is always better care.

Roxborough pediatrician Dr. Danielle Casher helped devise the guidelines for kids, which include limiting diagnostic imaging such as CT scans with mild head injuries. She said some patients think doctors are rationing care, but once she explains her reasoning about denying antibiotics or a certain test, parents are largely receptive.

"It's not about limiting care in a way that takes away from people, it's about steering providers and patients towards the best care," Casher said. "Sometimes the best care is less care."

The "top five" list in family, internal and pediatric medicine was published online in the Archives of Internal Medicine.