- Low-value healthcare services are responsible for millions of dollars in wasteful spending in Washington state, a new report by the Washington Health Alliance concludes.
- The group looked at 47 common treatment approaches known to be overused. Of those, 45% were found to be low-value or wasteful.
- Roughly 1.3 million people received one of the 47 services, and about half them received a low-value service — at a cost of $282 million, or 36% of the $785 million total spent on the 47 services. WHA used the national "Choosing Wisely" campaign’s definition of low-value healthcare services.
Despite widespread agreement that unnecessary care is bad for hospitals and patients, change has been slow. A recent analysis in Health Affairs found physicians often resist Choosing Wisely recommendations out of concerns about malpractice, patient demand and satisfaction and a desire for more information to reduce uncertainty. In another study published in Plos One, 84.7% of physicians surveyed said fear of malpractice led to overtreatment.
According to the National Academy of Sciences, about 30% of healthcare services are wasteful, which drives up costs. Choosing Wisely aims to reduce the incidence of low-value services by educating physicians who then educate patients.
In the Washington study, 11 services accounted for 93% of the low-value care and 89% of spend. Among them were too prescribing antibiotics for acute upper respiratory and ear infections, cardiac stress testing and imaging for uncomplicated low-back pain in the first six weeks.
“What’s interesting about this list is that it combines services that are both lower cost (less than $500) and higher cost (more than $500), dispelling a belief that overuse only refers to a problem of over-utilizing expensive testing, imaging, etc.,” the report says. “In fact, the problem of overuse is also one of excessive utilization of unnecessary low-cost services. When looked at individually, low-cost services don’t seem to be much of a driver, but when looked at collectively, they add up to a big problem.”
The report includes a “Call to Action” to address overuse. Key points include making overuse central to discussions of healthcare value, getting clinical leaders to take up the cause, incorporating Choosing Wisely concepts into provider-patient communications and paying for value over volume. They also recommend adding overuse measures in value-based provider contracts along with measures of access and underuse of care.