Low-Value Services Still Costing Insurers Millions

Nearly 8% of patients out of a national sample of almost 1.5 million commercially insured adults received health services considered low-value in 2013, according to a study in JAMA Internal Medicine. The cost of those services totaled $32.8 million.  

“In this commercially insured population, we found modest use of the low-value services assessed,” researchers reported, “but considerable corresponding potential savings.” 

The study focused on 28 services deemed low-value by the ABIM’s Choosing Wisely initiative. The most commonly received services included triiodothyronine measurement in hypothyroidism (1.5%), imaging for nonspecific low back pain (1.3%), and imaging for uncomplicated headache (1%).

When researchers looked at what low-value services garnered the largest shares of spending, they found $12.1 million (37% of spending) went toward spinal injection for lower-back pain, $3.6 million (11%) toward head imaging for uncomplicated headache, and $3.1 million (9.4%) toward imaging for nonspecific low back pain.

White patients of high socioeconomic status had the highest rates of overuse, according to the study. The Southern, Middle Atlantic, and Mountain regions had the highest spending on low-value services.

“Even in an era focused on value, these results reveal the degree to which physicians continue to perpetuate waste and the need for more work to change the culture of excess utilization,” observed Anna L Parks, MD, of the University of California, San Francisco, and Patrick G O’Malley, MD, MPH, Uniformed Services University of the Health Sciences, in an invited commentary. 

“As we strive to curb overuse, one area ripe for intervention may be how we communicate with patients about medical decisions, particularly those related to low-value care.”

The authors suggest the Choosing Wisely campaign ramp up efforts to raise awareness of low-value services to also include education for health care providers on how to discuss the wastefulness of such services with patients who request them. Easily accessible and evidence-based patient education materials on the Choosing Wisely website as well as communication best practices integrated into professional certification standards are two opportunities for improvement mentioned in the commentary.

“Physicians at all levels of training,” Dr Parks and Dr O’Malley concluded, “must take on the additional professional obligation of communicating risk and benefits clearly to achieve care that is both high-value and in line with patients’ goals.” —Jolynn Tumolo