Even though health systems have strong incentives to provide efficient, high-value care, their makeup and bureaucracy might provide other incentives that result in low-value care.
A study in JAMA Internal Medicine provides new insights into low-value care—i.e., care that is provided and paid for but has little or questionable medical value. Low-value care has been identified as an area where U.S. health care costs could be reduced, if replaced by higher-value practices.
The study, by researchers at Harvard and Dartmouth, found that low-value care was found more often in U.S. health systems in the South and West, in systems that had relatively lower numbers of primary care providers, in systems without a major teaching hospital, and in systems that served a higher proportion of non-white patients.
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Overall, the study found measurements that can be used to identify low-value care and provide data on how to improve the value of care delivered through U.S. health systems.
An ongoing problem
The study noted that low-value care has continued to be a problem in the U.S. in part because it has been difficult to document and study, particularly on a local level.
"Low-value health care remains prevalent in the US despite decades of work to measure and reduce such care," the authors wrote. "Efforts have been only modestly effective in part because the measurement of low-value care has largely been restricted to the national or regional level, limiting actionability."
To take a closer look, this study examined Medicare data from 556 U.S. health care systems. It found a variation of low-value care: some health systems gave almost none of their patients the identified low-value services, while in other health systems, a significant number of patients (28%) were given such services.
The study identified laboratory testing and prescription drugs as the areas where low-value services were most likely to be found.
Mixed incentives
The study outlined something of a paradox—even though health systems have strong incentives to provide efficient, high-value care, their makeup and bureaucracy might provide other incentives that result in low-value care.
"Health system organizational features are likely key drivers of low-value care through policy setting; workflows and protocols; culture; and compensation models," the report said.
"Even though hospitals are financially disincentivized to perform low-value inpatient services by the diagnosis-related group payment system, large health systems that offer many hospital-based procedures have higher commercial prices and incentives to refer patients to other system-affiliated clinicians and services," the authors wrote. "This situation may result in increases in marginal services, such as low-value magnetic resonance imaging studies."
The report concluded by saying that more research was needed to help health systems and policymakers devise tools to reduce the use of low-value care. The authors noted that more granular data would be useful to make focused changes in systems seeking to implement higher-value care.
"Health systems could use system-level data on low-value care to develop incentive schemes to reduce unnecessary care, educate their workforce, or link hiring and retention decisions to use of low-value services," the study said.
Overall, the researchers wrote, more measurement of low-value care will help identify problem areas and allow the health care industry to address them. "Even with its imperfections, the transparent and actionable measurement of low-value care is a critical step toward improving the quality and affordability of U.S. health care," the report said.
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