Eliminating routine but unnecessary procedures before people undergo cataract surgery has the potential to save costs and resources for hospitals serving lower-income patients, UCLA researchers have found.
They compared preoperative testing and costs for people undergoing cataract surgery at two major academic safety net hospitals run by the Los Angeles County Department of Health Services between April 2015 and April 2016.
They also analyzed patients' follow-up reports for an additional year to assess whether eliminating the preoperative care had a sustained result.
Forgoing routine chest X-rays, electrocardiograms and other preoperative procedures -- which were found to have no clinical benefit prior to cataract surgery -- was associated with a savings of $67,241 over three years at one of the medical centers analyzed in the study.
The change was also associated with other benefits -- for instance, one licensed vocational nurse had approximately 70 percent more time to pursue other clinical work. The researchers did not detect any measurable negative effects for patients associated with the change.
A 2000 study in the New England Journal of Medicine found that routine preoperative tests for cataract surgery are of limited medical value for patients, but a later study, published in the same journal in 2015, found the procedures are still commonly performed across the healthcare system.
Many low-value services have been identified that could be sources of potential waste. In 2017, Health Affairs published a list of common, low-value care services and what providers can do about them.
Diagnostic testing and imaging for low-risk patients prior to low-risk surgery was first on the list, as it can cause unnecessary care delays and additional low-value testing and costs. Population-based vitamin D screening came in second.
ON THE RECORD
"As health systems, policymakers and payers across the United States face mounting pressure to safely lower healthcare spending, these findings highlight one potential clinician-led approach associated with reduced low-value care, lower costs and improved quality in the safety net health system setting," said Dr. John Mafi, an assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and the study's lead author.