September 15, 2022 – Less is more: Is it true regarding healthcare services and procedures? Many clinicians think so but have found that eliminating “low-value care” is more difficult than it sounds.
Research shows that fear of malpractice, patient demands and old med school habits continue to drive physicians to provide diagnostic, imaging and pharmacological services that do little good for their patients, and at worst, lead to poorer health outcomes. It’s called low-value care and has been defined as services that are of limited to no benefit to patients, may cause patients harm, and lead to waste of healthcare resources.
“The potential negative consequences of medical overuse include adverse effects of treatments and procedures, invasive and dangerous follow-up tests and treatments, overdiagnosis, psychological harm, treatment burden, social consequences, and dissatisfaction with health care,” concludes Niloofar Latifi, M.D., of John Hopkins School of Medicine, writing in a JAMA Internal Medicine editorial in December 2021. For example, routine preoperative electrocardiograms before cataract surgery have been associated with a cascade of testing, treatment, and specialist referral at an estimated annual cost for Medicare of $35 million, she says. Low-value testing in annual health examinations has been associated with more specialist visits and additional noninvasive and invasive testing.
Based on the principle of avoiding services with no or minimal benefit to patients, the American Board of Internal Medicine Foundation in 2012 helped launch the Choosing Wisely® campaign. The program calls for professional societies to create lists of low-value services that physicians should avoid and encourages physicians to engage in conversations about overuse.
The campaign started with lists from nine medical societies and has since grown to include lists from more than 80 societies, citing more than 600 procedures in total. In addition, the program has spread beyond U.S. borders to 25 other countries, including Canada, the United Kingdom, Germany, and Japan.