Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

AHA: Limiting Low-Value Medical Resource Use Cuts Healthcare Costs

Providers can reduce healthcare costs by implementing monitoring and educational tools that discourage lower-value medical resource use, says AHA.

By Jacqueline LaPointe

- While it is always reassuring to know that a provider will stop at nothing to diagnosis and treat his patients, limiting some medical resource use may actually help to decrease healthcare costs and improve quality of life for some patients, reported the American Hospital Association (AHA).

Providers can reduce healthcare costs by monitoring low-value medical resource use

In a guide on appropriate resource use, the AHA advised healthcare organizations to implement monitoring and educational tools for providers that encourage limited use of certain tests that may not improve care quality.

“As medical societies, provider organizations, and others look for ways to drive appropriate use of medical resources, hospitals and health systems can play an important role in supporting and guiding these efforts within their organizations,” stated the AHA.

“As one of the more intense healthcare resource users, hospitals and health systems have a responsibility to encourage appropriate and consistent use of healthcare resources and give providers the tools to better communicate with patients about appropriate use of resources.”

Stemming from the era of fee-for-service reimbursement, providers have increased the volume of procedure-based interventions and treatments because they were financially incentivized to perform more services. Providers were also motivated to increase resource use by the abundance of medical information made available by new tests and the web, malpractice concerns, and the industry-wide “try-everything” approach to treatment, wrote AHA.

READ MORE: Lean Primary Care Improves Physician Productivity, Costs

However, in light of the rise of value-based reimbursement models, monitoring resource use is key to reducing healthcare costs and maximizing financial rewards. For example, MACRA’s proposed Merit-Based Incentive Payment System would award points to eligible clinicians for demonstrating appropriate medical resource use, which could lead to value-based incentive payments.

While providers should ensure that their patients are being treated when necessary, healthcare organizations should encourage their staff to limit lower-value treatments, the AHA stated. Lower-value treatments tend to cause over-diagnosis and over-treatment, which reduces a patient’s quality of life and does not improve their chances of getting better.

For example, a BMJ study from 2013 found that new imaging methods and biopsies of smaller nodules had caused in increase in thyroid cancer diagnoses, but it has not improved mortality rates. Despite the fact that many papillary thyroid cancers may never progress to cause symptoms or deaths, many patients are still being treated, which can lead to serious side effects and lower quality of life. Earlier diagnosing of cancer may also lead to longer and more aggressive treatments, even though mortality rates remain the same, the AHA noted.

The AHA listed the following hospital-based procedures that providers should review and discuss with patients before performing them:

• Blood management services in inpatient services

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• Prescribing antibiotics

• Inpatient admissions for ambulatory-sensitive conditions, such as lower back pain, asthma, and uncomplicated pneumonia

• Use of elective percutaneous coronary intervention

• ICU use for imminently terminal illness

“By reducing the utilization of non-beneficial care – care that increases costs without a concomitant increase in value – we can have a delivery system that achieves the Triple Aim…improved health, a quality patient experience, and lowered costs,” explained the AHA.

READ MORE: Higher Hospital Costs Stem from ICU Overuse for Some Conditions

In addition to specific procedures, healthcare organizations should develop patient engagement strategies that encourage shared decision-making. The AHA cited a study that found shared decision-making lowered overall healthcare costs by 5.3 percent and reduced hospital admissions by 12.5 percent. The AHA stated that patient engagement methods, such as phone calls or emails, can help providers chose the most appropriate treatment for patients while reducing utilization and costs.

Healthcare organizations should also offer providers educational resources on appropriate use of medical resources, the AHA wrote. The industry group recommended the use of academic detailing, or direct outreach education through state-run programs or medical professional societies, which provides staff with accurate and unbiased information.

Additionally, the guide presented the following initiatives for hospitals and healthcare systems to help decrease the use of lower-value services:

• Use quality measures that track overuse of non-beneficial care services to monitor and report on appropriate resource use

• Distribute and employ specialty society clinical practice guidelines and use them in clinical decision-making processes

• Encourage the use of clinical decision aids and other tools to support physician communication with patients about appropriate treatment plans

• Provide organizational and technological structures for patients and providers to have meaningful discussions about appropriate resource use, such as EHR prompts for providers

• Offer educational resources and opportunities to communicate the effectiveness of shared decision-making and reducing lower-value services

While some payment reforms, such as MACRA, are driving appropriate resource use, the AHA stated that providers, who are the biggest user of medical resources, have the “greatest opportunity for success in reducing costs and improving healthcare.”

“[W]e need to ensure that the underlying systems are in place for education around appropriate use of resources, sharing of comparative effectiveness data, the development and adherence to evidence-based clinical protocols, and shared decision-making with engaged patients.”

Dig Deeper:

Preparing the Healthcare Revenue Cycle for Value-Based Care

How to Bend Healthcare’s Cost Curve Over the Next Decade


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