Healthcare Framework Aims to Drop Low-Value Resource Use, Costs

May 17, 2017 - Healthcare organizations looking to reduce low-value resource use and healthcare costs should implement a framework that addresses the patient and clinician interaction, according to a recent Journal of Hospital Medicine report.

Four physicians and industry experts argued that inappropriate resource use stems from the patient and clinician interaction. In response, they developed a framework that addresses the drivers of resource overuse, including the patient-clinician experience, medical and patient culture, practice environment and incentives, and clinician and patient factors.

“Conceptualizing overuse through the patient–clinician interaction maintains focus on patients while promoting population health that is both better and lower in cost,” they wrote. “This framework can guide interventions to reduce overuse in important parts of the healthcare system while ensuring the final goal of high-quality individualized patient care.”

Identifying the drivers of low-value resource use is key to decreasing healthcare costs. Despite representing just 0.5 percent of total healthcare spending, stakeholders spent about $32.8 million on 28 low-value medical services in 2013, a 2016 study showed.

The healthcare industry as a whole also spent over $750 billion annually on wasteful goods and services, with $200 billion of that spending attributed to overtreatment.

Many healthcare organizations and stakeholders have attempted to develop resource use initiatives and guidelines to reduce medical service overuse and high healthcare costs, such as the guideline-based Choosing Wisely campaign.

“Initiatives to reduce overuse have targeted physicians, the public, and medical educators but have had limited impact,” the report stated. “Few studies have addressed methods for reducing overuse, and de-implementation of nonbeneficial practices has proved challenging. Models for reducing overuse are only theoretical or are focused on administrative decisions.”

For example, a 2015 JAMA Internal Medicine study showed that providers participating in the guideline-based Choosing Wisely campaign only decreased low-value resource use for two out the seven services studied.

Another 2013 report in the same journal also found that providers were more effective at improving unnecessary resource underuse than reducing inappropriate care.

To help healthcare organizations reduce low-value resource use and healthcare costs, the physicians and industry experts contended that a resource use framework should be created to combat medical service overuse.

Based on a review of conceptional frameworks and related literature as well as feedback from the Preventing Overdiagnosis 2015 conference, the authors developed a resource use framework that is patient-centered to target the greatest low-value resource drive.

“During framework development, the patient–clinician interaction emerged as the nexus through which drivers of overuse exert influence,” the researchers wrote. “The centrality of this interaction has been demonstrated in studies of the relationship between care continuity and overuse or utilization by evidence that communication and patient–clinician relationships affect utilization and by the observation that clinician training in shared decision-making reduces overuse.”

Since providers order treatments during the visit, healthcare organizations should focus on combatting low-value resource use drivers in this domain first. The drivers include communication styles, race, culture, language, gender, and visit priorities.

Healthcare organizations can also look to other areas to target low-value resource use. The next greatest influence on low-value resource use was the practice environment, including financial incentives, practice norms, care delivery policies, lawsuit risk, and performance metrics that may promote overuse.

Clinicians and patients also faced different low-value resource use drivers. Providers tended to prescribe more inappropriate medical services because of the culture of professional medicine and clinician attitudes and beliefs.

The culture of professional medicine and clinician beliefs influenced providers to overtreat some patients because of the following factors:

• Value placed on being certain

• Value placed on being productive or busy

• Fear of missing diagnoses

• New health IT solutions with more value and reimbursable

• Personal bias

• Previous experiences with particular patients

• Fear of litigation

• Clinician interactions with peers and other staff

• Discomfort with discussing healthcare costs with patients

On the other side, patients were up against the culture of healthcare consumption and experiences. The rise of healthcare consumerism and previous patient interactions caused some patients to encourage overtreatment.

Although the provider-level drivers tended to impact low-value resource more than patient-facing drivers, researchers added.

Healthcare stakeholders can apply the resource use framework to reduce low-value services and healthcare costs by targeting interventions based on the appropriate driver. For example, organizations can change clinician beliefs through audits and feedback, education, and role models.

Providers can overcome patient biases via education, increased price transparency, and robust patient engagement initiatives.

For healthcare organizations in particular, researchers added that the resource use framework “can ground root cause analyses of overuse-related problems and inform allocation of limited resources.”