Providers Skeptical Practice Variation Reduction Will Lower Costs

February 14, 2018 - Clinicians strongly agreed that providers should be responsible for reducing healthcare costs, but fewer clinicians felt that decreasing practice variation would lower costs, a recent Plos One study uncovered.

The survey of over 170 physicians, 60 nurse practitioners, and 12 physician assistants found that on a scale of one to six, with one representing strongly disagree and six representing strongly agree, clinicians only rated reducing practice variation as a means to lower healthcare costs 4.4 points.

But practice variation is linked to wasteful healthcare spending, research shows. Unwarranted practice variation contributed to about 42 percent of wasteful healthcare spending, according to the Advisory Board.

Despite care variations leading to wasteful spending, clinicians were still skeptical of practice standardization’s ability to reduce healthcare costs. Surveyed providers expressed a lack of confidence in the industry’s ability to actually decrease practice variation.

When asked to rate if practice variation can be realistically reduced, only 43 percent of clinicians agreed that it could.

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But surveyed clinicians still felt that practice variation should be reduced. The surveyed providers generally agreed that decreasing practice variation would benefit most patients, with an average rating of 4.6 points.

The survey revealed that a lack of time to identify and apply care standards was the greatest barrier to reducing practice variation. On a scale of one to four, with four being most helpful, respondents rated time as having the highest impact on care standardization with a score of 3.5 points.

Clinicians also agreed that patient decision aids would help reduce practice variation (3.1 points), followed by institution-wide standard practices (3.1 points) and standardized order sets (3.1 points).

Having another provider or staff member order common tests ranked the lowest on most helpful strategies for care standardization with just 2.3 points.

Healthcare organizations may also want to increase practice standard and guideline accessibility to reduce practice variation and healthcare costs. About 52 percent of respondents reported that practice standards and guidelines were hard to find and apply to their care delivery.

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Following practice standards and guidelines is a top priority for clinicians even though they questioned if providers could realistically engage in practice standardization to reduce healthcare costs. Approximately 94 percent of respondents agreed that they depend on practice standards and guidelines to provide patient care.

Clinicians also generally agreed that they modify their care delivery processes to align with new guidelines and that providers should apply new research findings to their practices. Each of these responses earned an average score of 4.5 points on a scale of one to six.

About 96 percent of respondents also stated that clinicians should encourage their patients to follow guideline recommendations.

Additionally, the survey showed that nurse practitioners and physician assistants depended more on practice standards and guidelines for patient care than physicians. These clinicians rated more highly than physicians their trust in research, dependence on practice guidelines, and speed to align with practice guidelines.

Although physicians in the early phases of their career favored practice standards and guidelines more than late-career physicians. Early- and mid-career physicians expressed higher agreement than late-career clinicians on dependence on practice guidelines.

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They also rated time, institution-wide standard practices, and decision aids as more helpful in reducing practice variations than late-career physicians.

While clinicians generally agreed that they follow guidelines when providing care, researchers warned that clinician perceptions may be exaggerated.

“Moreover, clinicians' perceptions of their own guideline adherence is typically more favorable than reality,” they wrote. “Yet even if clinicians are mistaken in their beliefs, their perceptions must be taken seriously and at face value. It will be difficult to fix the problem if those involved fail to recognize its magnitude, importance, or potential for correction.”

To reduce practice variation, healthcare organizations will need to change clinician attitudes regarding practice variation and solutions.

“Systems-level solutions will play an essential role in standardizing practice, but attempts to circumvent clinicians, i.e., through automated implementation of guidelines, may backfire,” researchers explained. “We note, for example, that the lowest-rated item on our survey was a potential practice change in which someone else would order common or straightforward tests.”

Healthcare organizations should also acknowledge that clinicians need time to apply practice standards and guidelines, researchers explained.

“Perhaps most importantly, our respondents indicated that the factor anticipated to most help standardize their clinical practice is not new standards or better access to guidelines, but is rather time to apply existing standards,” they concluded. “This suggests that instead of focusing attention exclusively on developing and implementing guidelines, we might have more success by freeing up clinicians' time or reducing the time needed to apply patient-tailored guideline recommendations”

“Since decreasing clinicians' time burden is likely unrealistic (and, even if achieved, might not actually be used to study and apply standards), we propose to focus on how to efficiently integrate practice standards into clinicians' workflow,” they wrote.