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Unnecessary Care: It’s Not Necessary

November 2, 2017
by Suresh Yarlagadda, Medical Director, Clinical Strategy, Change Healthcare
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Unnecessary care is unnecessarily in the news these days. We say “unnecessarily” because such care—as well as the associated costs it incurs and risks it poses for patients—can be mitigated.

Kaiser Health News just published a report, “So Much Care It Hurts: Unneeded Scans, Therapy, Surgery Only Add to Patients’ Ills” which describes aggressive over-treatment for breast cancer. And a story in Health Affairs, “Low-Cost, High-Volume Health Services Contribute the Most to Unnecessary Health Spending” showed that a preponderance of prescribed low-value health services offered little medical value while increasing patients’ costs.

From region to region and physician to physician, there’s a lot of unexplained variation in medical care provided to patients. Indeed, the Institute of Medicine estimates that $210 billion is spent on unnecessary medical testing and medical care annually in the United States. In addition to driving up healthcare costs, unnecessary medical care can also be harmful to patients.

Researchers from Johns Hopkins and Harvard recently conducted a study, published by PLOS One, to better understand the reasons behind unnecessary medical care. The study surveyed 2,106 physicians from the American Medical Association master file, and asked about reasons behind overtreatment; the extent of overutilization; as well as the causes, solutions, and implications for healthcare.

The result: Surveyed physicians reported that 20% of the medical care provided today was unnecessary. Unnecessary care includes testing, medications prescribed, procedures, admissions, specialty referrals, BH therapy, use of DME, and more. Common reasons stated by participants for overtreatment were fear of malpractice (85% of those surveyed), patient pressure or request (59%), and difficulty accessing medical records (38%). Potential solutions suggested were training residents on appropriateness criteria (55%), improving access to outside health records (52%), and developing and using more practice guidelines (51%). Following the recommendations of Choosing Wisely, a physician-led initiative that is intended to decrease the use of inappropriate tests and procedures, may also be helpful.

This study has added importance because the participants were practicing physicians, and the amount of unnecessary care that they agreed was being provided to patients was so great. And in addition to the financial cost, care that is medically unnecessary has the potential to cause patient anxiety or actual harm. If unnecessary care could be cut in half—an aspirational but potentially achievable goal given the tools at physicians’ disposal today—the $105 billion saved, or 4% of annual healthcare costs, could be used to provide care that is actually needed. And even incremental progress will result in cost savings and improved outcomes.

Much unnecessary care, whether it is testing, medications, procedures or more, can be avoided by using evidence-based medicine tools, such as those provided by InterQual. By promoting the delivery of medically necessary and appropriate care and discouraging use of unneeded tests and procedures, etc., these decision-support tools help physicians provide cost-effective, high-quality, consistent care—and that helps the healthcare system improve care value and ensure care is truly medically necessary.

References:

Lyu H, Xu T, Brotman D, Mayer-Blackwell B, Cooper M, Daniel M, et al. (2017) Overtreatment in the United States. PLoS ONE 12(9): e0181970  https://doi.org/10.1371/journal.pone.0181970

So Much Care It Hurts: Unneeded Scans, Therapy, Surgery Only Add to Patients’ Ills, Kaiser Health News:  https://khn.org/news/so-much-care-it-hurts-unneeded-scans-therapy-surgery-only-add-to-patients-ills/

Low-Cost, High-Volume Health Services Contribute the Most To Unnecessary Health Spending, Health Affairs:  http://content.healthaffairs.org/content/36/10/1701.abstract

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