This article is more than 5 years old. Information may no longer be current.

Limiting low-value care services would result in 'substantial' health care savings

Spending on low-value health care services represents a large area of waste in the U.S. health care system, according to data published in JAMA Internal Medicine.

Researchers identified $32.8 million in spending on 28 low-value services among a sample of commercially insured patients in 2013 alone.

Rachel O. Reid, MD, MS, from the RAND Corporation and Brigham and Women's Hospital, and colleagues wrote that while patients are receiving these low-value procedures, they are less likely to get high-value care.

"More than $750 billion of U.S. health care spending annually represents waste, including approximately $200 billion in overtreatment," they wrote. "Reducing overuse could improve quality and access while reducing spending and has been championed by clinicians through the Choosing Wisely initiative, as well as payers and policy-makers.”

Reid and colleagues noted that previous research of low-value care has directly assessed only Medicare data or included limited measures or geographic area.

They analyzed insurance claims from 1,468,689 patients aged 18 to 64 years across the U.S. for 28 low-value services.

Patients most commonly received imaging for uncomplicated headache (1%), imaging for nonspecific low back pain (1.3%) and triiodothyronine measurement in hypothyroidism (1.5%). Spending was highest for imaging for nonspecific low back pain at $3.1 million (9.4%), head imaging for uncomplicated headache at $3.6 million (11%) and spinal injection for lower-back pain at $12.1 million (37%).

"The services in this study reflect many clinical areas and types of care, but are still a small portion of all the low-value care patients receive," Reid said in a press release. "The potential savings from reducing these low-value services and others are substantial."

In addition, low-value spending was higher in patients who were male, older, Asian, black, had lower incomes or were enrolled in a Consumer-Directed Health Plan.

"Disparities in health care cut two ways — it can cause poor access to high-value care among vulnerable patients and overuse of low-value care among more-advantaged groups," Neeraj Sood, PhD, professor and director of research at the Leonard D. Schaeffer Center for Health Policy at the University of California and senior author of the study, said in a press release. "Both need attention."

Reid and colleagues concluded: "Efforts to reduce waste in health care may be bolstered by measure development efforts that focus on overtreatment, insurance designs that discourage overuse, and programs that target groups and regions at greater risk of low-value care."

In an accompanying editorial, Anna L. Parks, MD, from the University of California, San Francisco, and Patrick G. O'Malley, MD, MPH, from the Uniformed Service University of the Health Sciences, wrote that while the American Board of Internal Medicine has worked to target low-value care via its Choosing Wisely initiative, the current research "demonstrates the persistent disconnect between publicizing examples of waste and achieving value-based care in practice."

"Even in an era focused on value, these results reveal the degree to which physicians continue to perpetuate waste and the need for more work to change the culture of excess utilization," they continued. "As we strive to curb overuse, one area ripe for intervention may be how we communicate with patients about medical decisions, particularly those related to low-value care. Both trainees and practicing clinicians appear to lack adequate skill in accurately discussing the risks and benefits of care in a shared manner." – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.