09 Oct Low-Cost, High-Volume Services Add Billions To US Health Care Tab
MedicalResearch.com Interview with:
John N. Mafi MD MPH
Assistant Professor of Medicine
David Geffen School of Medicine
University of California, Los Angeles
Natural scientist in Health Policy
Santa Monica, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Of the 3 trillion dollars the U.S. spends annually on health care, an estimated 10-30% consists of “low-value care”, or patient care that provides no net benefit in specific clinical scenarios (think antibiotics given for the common cold virus). Determining where and why this waste occurs is critical to efforts to safely reducing healthcare spending. Little is known, however, about the distribution of costs among such “low-value” services. In this context, we used the Virginia All Payer Claims Database in order to assess the quantity and total costs of 44 low-value services in 2014 among 5.5 million beneficiaries.
MedicalResearch.com: What should readers take away from your report?
Response: In 2014, Virginia spent $586 million on low-value care according to our 44 measures, or approximately 2% of Virginia’s total healthcare spending. Nearly two thirds of unnecessary spending consisted of high-volume, low-cost services ($538 or less) such as pre-operative lab testing for low-risk surgeries.
These findings are important because decreasing unnecessary health care spending can reduce patient harm (both medical harm say from complications from unnecessary procedures, and financial harm from unnecessary out-of-pocket spending) and improve the efficiency of care by shifting resources away from low-value scenarios to areas that are proven to enhance patient-centered outcomes. These results are also important because they suggest that in aggregate, minor actions by all clinicians can potentially play a considerable role in reducing unnecessary health care costs.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future studies need to achieve several goals as soon as possible.
First, future work should develop many more valid and reliable measures low-value care, as our 44 measures only represent a small fraction of unnecessary care.
Second, future studies need to identify specific health system, clinician, and patient-level characteristics associated with low-value care, as understanding where and why low-value care occurs will be critical for efforts to eliminate it.
Third, and perhaps most importantly, we need an unprecedented number of pragmatic clinical trials (both randomized, and non-randomized) that identify successful ways in which health care systems can accurately identify and durably eliminate low-value care, with minimal expense, clinician workflow disruptions, or harmful unintended consequences (such as depriving patients of necessary care).
MedicalResearch.com: Is there anything else you would like to add?
Response: My hope is that this work will stimulate conversations among health care leaders and policymakers in both the government and private sectors about how to get serious about (safely) eliminating some of the lowest-hanging fruit in our health care system.
I (John Mafi) have no conflicts to disclose. See our acknowledgements section at the end of the paper for other disclosures.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
John N. Mafi, Kyle Russell, Beth A. Bortz, Marcos Dachary,William A. Hazel, Jr., and A. Mark Fendrick
Health Aff October 2017 36:101701-1704; doi:10.1377/hlthaff.2017.0385
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