- Healthcare organizations can cut down on costly low-value services, such as antibiotic prescriptions for acute sinusitis or osteoporosis screenings for young patients, by educating primary care providers about healthcare costs, a recent study in the Journal of the American Board of Family Medicine indicated.
The survey of almost 150 primary care providers showed that providers who reported higher healthcare costs consciousness also performed less low-value services and said they were more familiar with clinical guidelines compared to providers with low scores.
Healthcare spending is not sustainable, researchers stated, and low-value services contributed to unnecessary healthcare spending. Almost one-quarter of total healthcare spending, or $750 billion, is related to low-value services, according to a cited 2008 Congressional Budget Office testimony.
Low-value primary care services account for a large portion of wasteful spending, the study added. A cited 2011 study in JAMA Internal Medicine showed that non-recommended primary care services as defined by the Good Stewardship Working Group cost the industry about $5 billion each year.
Using a top five low-value services list from the American Academy of Family Physicians, the study showed that primary care providers have high low-value service utilization rates, such as antibiotic treatment for acute sinusitis.
Even though surveyed primary care providers had the greatest knowledge of clinical guidelines on acute sinusitis treatment, providers still reported high rates of antibiotic prescribing for the condition, which is considered a low-value service. Out of the top five low-value services, providers performed this one the most.
Providers stated that they still preformed the low-value service because of practice-related challenges, including difficulty reconciling patient preferences, limited time to address appropriateness, and lack of resources to address low-value services in practice.
In addition to practice-related barriers, primary care providers also stated that attitudinal challenges significantly contributed to more low-value service utilization, researchers claimed.
For example, providers reported high rates of low-value osteoporosis screenings for young, low-risk patients. Providers explained higher rates were caused by attitudinal barriers, such as difficulties applying guideline concepts in practice, changing habits, developing clinical inertia, boosting self-efficacy to change behaviors, and agreeing about cost-to-benefit ratios of making changes in practice.
Researchers found that primary care providers performed less low-value services when they perceived less practice-related and attitudinal barriers. For instance, providers reported giving less pap smears for patients who had a hysterectomy for a non-cancer indication because of less barriers.
To reduce low-value services in practice, researchers advised organizations to educate their primary care providers on healthcare costs, rather than clinical guidelines. Providers with higher healthcare cost consciousness scores not only performed less low-value services and knew more about clinical guidelines, but they also reported fewer perceived barriers to guideline adherence.
While clinical guideline distribution increased healthcare cost awareness, researchers found that it did not lead to less use of low-value services.
Researchers also found that greater familiarity with the Choosing Wisely campaign was associated with reduced use of low-value services. The campaign aims to open discussions about low-value services across the healthcare continuum and help providers avoid these tests and treatments when they can.
Providers who stated they were very familiar with the Choosing Wisely campaign also reported the lowest low-value service utilization rates, the study showed.
The Choosing Wisely campaign was more effective at reducing low-value service use than patient-centered medical home certification status, value-based insurance participation, and accountable care organization participation, researchers noted.
Boosting healthcare cost consciousness among providers may also help organizations to significantly reduce healthcare costs. An August study from the RAND Corporation and the University of South California found that healthcare stakeholders spend about $32.8 million on 28 low-value services in 2016.
In the same month, the American Hospital Association (AHA) released a guide on how to avoid low-value services and lower healthcare costs. The industry group advised providers to avoid several hospital-based procedures, including blood management service in inpatient settings, antibiotic prescriptions, inpatient admissions for ambulatory-sensitive conditions (e.g. lower back pain and asthma), use of elective percutaneous coronary interventions, and ICU use for imminently terminal illness.
The organization also emphasized that hospitals and health systems are responsible for lowering healthcare costs through more appropriate resource use.
“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.”