The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review
Choosing Wisely recommendations aim to reduce the use of low-value health services, but in order to be effective, they must be coupled with interventions to implement them. In an effort to inform policymakers, health system leaders, payers, and clinicians about the components needed for successful implementation, Milbank Quarterly published a literature review providing an updated analysis of interventions and their impacts on specific low-value services from 2012-2019.
Reducing Health Care Spending: What Tools Can States Leverage?
As health care spending continues to rise, state governments are charged with identifying strategies and implementing policies to control spending growth. Findings from a recent Commonwealth Fund study suggest that states will pursue a variety of strategies depending on resources, priorities, and healthcare landscape. These strategies may range from promoting competition, reducing prices through regulation, and designing incentives to reduce the utilization of low-value care to more holistic policies, such as imposing spending targets and promoting payment reform.
Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study
In alignment with the above systematic review by Milbank Quarterly, authors of a recent JGIM article also assert that dissemination of Choosing Wisely recommendations alone will not serve to change physician behavior and reduce the prevalence of low-value care. In this study, researchers assess the effectiveness of quality circles (QC’s) as an intervention to drive practice change. Findings suggest that educative feedback can be used as a tool to encourage physicians to analyze their own practices and determine whether there is opportunity to implement higher-value practices.
To Expand the Evidence Base About Harms from Tests and Treatments
When considering the potential benefits or harms of a healthcare intervention, the process of patient-centered evidence-based care relies on available evidence to inform decisions. Authors of a recent study suggest that while efficacy data is readily available, evidence needed to comprehensively evaluate potential harms is lacking, often making this process biased and one-sided. Authors recommend that in order to achieve fully informed decision-making, researchers, healthcare professionals, and patients must consider seven domains of potential harm resulting from a test or treatment.
Unnecessary Medical Procedures, Sherman Sorensen, and the False Claims Act - The Atlantic
Unlike prescription drugs or medical devices, tens of millions of surgical procedures performed in the U.S. each year are not subject to government oversight. While cost and access are often highlighted in political debates about health care, the issue of whether a service is high- or low-value is often missing from the discussion. This Atlantic profile article highlights the story of a patient who received an unnecessary procedure that led to further complications, compromised quality of life, and – eventually – an even riskier reversal surgery and a lawsuit. Read the compelling account here
What Low-Value Care Means for Health Equity
Expanding access to health care is an important strategy in advancing health equity, but not all routinely delivered care improves health outcomes. In this PhRMA blog post, researchers suggest that the burdens of low-value care on marginalized and underserved patients – including potential harm, unnecessary costs, and waste of limited health care resources – may exacerbate health disparities. Further research on the prevalence and impact of LVC in minority communities is needed to better inform efforts to increase access, improve health, and enhance equity. Read the full article here.
Overzealous Women’s Health Screening? My Story
“Women are often misinformed about screening risks and thus cannot properly weigh them,” experienced epidemiologist Rani Marx states in an article chronicling her experience as a patient within the landscape of women’s healthcare. Despite her background and extensive research concerning her private health care, Marx found herself feeling railroaded into accepting unnecessary, distressing, and uncomfortable screenings by physicians who insisted on advising against evidence-based recommendations. Read her story here.