Chasing better value in health care
November 19, 2023
As different organizations consider how to be more efficient with healthcare dollars, people have been trying to identify and eliminate "low-value care" -- care that costs money or time, but do not actually improve health outcomes. In a previous era where doctors were paid more to do more (and perhaps when budget constraints were less of a concern), it is understandable how low-value care was incorporated into clinical protocols ("just in case" or "why not?"). KFF Family News reports that "Of the $3 trillion spent each year on health care in the U.S., 10% to 30% consists of this low-value care" and that eliminating low-value care is challenging.
Part of the issue is organizational momentum -- when guidelines and protocols that included such low-value care were developed and integrated into the organization's workflow, it can be difficult to change people's patterns. Part of the problem is satisfying concerned patients (or parents) who might feel that without certain tests or imaging, a diagnosis might not be thorough enough. The article quoted one physician as saying "One of the hardest things to do in this work is to align financial incentives."
Yet, the article reports that when low-value tests or imaging appear to reveal a potential problem, follow-up tests cost money, but do not actually improve results -- that is, they were "false positives" that yielded warnings when there was actually no need for concern. To be clear, these tests and imaging procedures can be helpful in other contexts, but may be low-value in specific contexts (e.g. for certain conditions) that provider organizations may need to spend time to identify.