Providing more low-value care does not improve physician ratings
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Researchers found no association between low-value services and patients’ ratings of their health care experiences, an analysis of Medicare claims showed.
Patient experiences and ratings are often used “to incentivize quality improvement through public reporting and performance-based payments,” according to researchers.
The widespread use of patient-reported health care experiences may “encourage physicians to provide more low-value services (care that is not associated with a clinical benefit), out of a belief that responding to patient demand or the perception that more care is better will improve their ratings,” Prachi Sanghavi, PhD, an assistant professor of biological sciences in the department of public health sciences at the University of Chicago, and colleagues wrote in JAMA Internal Medicine.
“This may lead to the wasteful use of health care resources and spending, possible iatrogenic injury and limited success of alternate payment models such as accountable care organizations,” they said.
Previous studies evaluating this association did not “adequately” adjust for certain factors, “like how sick a patient might be, which could be a confounding factor,” Sanghavi said in a press release.
“For example, people who are chronically or terminally ill may use more care and may develop closer relationships with their doctors, which could in turn lead to higher patient satisfaction ratings,” she added.
Sanghavi and colleagues analyzed Medicare fee-for-service claims covering approximately 26 million beneficiary-years and 100,743 primary care professionals from Jan. 1, 2007, to Dec. 31, 2014, to ascertain who would have low-value services unnecessarily ordered for them. These low-value services included PSA testing in older men, screening for carotid artery disease in asymptomatic adults, cervical cancer screening for older women, parathyroid hormone test for patients with stage one to three chronic kidney disease, free T3 level testing for patients with hypothyroidism, back imaging for nonspecific low back pain, spinal injection for low back pain and head imaging for uncomplicated headache.
The researchers also examined health care experience reports from independently sampled beneficiaries who answered 2010 to 2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare fee-for-service survey questions regarding overall health care, appointment waiting time, timely access to nonurgent and urgent care, overall rating of personal physician, clarity of communication, careful listening, respect and adequate time.
According to Sanghavi and colleagues, the only “notable association” they found was a link between more low-value care exposure and more frequent reports of patients waiting longer than 15 minutes after a scheduled appointment time. On average, patient panels who had the most exposure to low-value care rated this variable 0.448 points lower on a 10-point scale assessing CAHPS compared with patient panels who had the least exposure to low-value care.
“Although some other associations were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure,” the researchers wrote.
The findings suggest that physician concerns that more low-value care translates to better patient reviews are “overblown,” study co-author Michael McWilliams, MD, PhD, professor of health care policy at Harvard Medical School and a general internist at Brigham and Women’s Hospital, said in the press release.
“We should be reassured that we can tackle waste in the system without great patient backlash or flunking providers on their ‘scorecards,’” he added.