Spending on low-value healthcare services persists, but it's not the low-value services with big price tags driving spending, it's the low-cost ones performed more often that are the culprits, according to a new study from Health Affairs.
Low-value care is defined as services that "provide no health benefit in specific clinical scenarios," the study said, using as an example early diagnostic imaging for uncomplicated low back pain.
Health Affairs researchers used data from the Virginia All Payer Claims Database, which includes administrative claims data about state residents insured through fee-for-service Medicare, Medicare Advantage, Medicaid, and private commercial insurers. Claims data from 2014 for 5.5 million beneficiaries was used. Researchers looked at 44 health services that were deemed low value, including baseline lab tests for low-risk patients having low-risk surgery, annual ekg's or other cardiac screenings for asymptomatic patients, population based vitamin-D deficiency screenings and other services.
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Researchers analyzed 5.4 million of the 44 health care services included in the study received by Virginia beneficiaries and found that 1.7 million of them were low-value -- which cost more than $586 million. That is equal to 2.1 percent of Virginia's healthcare costs, which totaled $28 billion that year, the study said.
That data also showed 93 percent of low-value services utilized were low-cost services, those priced at $100 to $538 per service, or very low cost, those priced at less than $100. That's in contrast to the 7 percent that were high-cost services priced at $539 to $1,315, and very high cost, those more than $1,315.
Specifically, 1.6 of the 1.7 million services found to be low-value were also low or very-low cost. Those low-value, low-cost services themselves amounted to $381 million, researchers said.
"Demonstrating the relative excessive use and costs of low-value services is particularly salient because these findings should indicate a pragmatic path to begin their reduction. Although changing any physician practice pattern (including the delivery of routine and low-cost services) is notoriously difficult, even a modest decrease in the use of low- and very-low cost low-value services could lead to savings and serve as a feasible strategy for catalyzing a broader movement to tackle low-value care," study authors wrote.
They also proposed that efforts aimed at reducing the utilization of low-cost low-value services rather than the pricier ones could prove less controversial because it would pose less of a threat to clinical specialties or advocacy groups.
It's also important to note that authors called their cost estimates conservative since they don't capture the "downstream costs" related to low-value care. An example is an instance where an abnormal cardiac stress test is administered to someone who isn't showing symptoms, which is an example of low-value care, and that patient might then undergo a cardiac catheterization as a result of the test, also an unnecessary service.
They said estimates will likely climb as more services are pinpointed and as researchers shift their methods to include electronic health records over claims databases. Researchers said EHRs contain better data, and should be used as providers fall under increasing pressure to cut unnecessary spending.
"Decreasing wasteful healthcare spending will reduce patient harm and improve the efficiency of delivery by shifting care away from low-value circumstances to clinical scenarios that improve patient-centered outcomes," authors said.