Health care costs continue to be a concern for individuals, families, and public and private sector employers, as we’ve written before (see here and here). A new report from the Washington Health Alliance illuminates a strategy for reducing cost without compromising care: reducing ‘low-value health care services.”
Here’s how the WHA looks at the challenge:
“First, do no harm” is one of the principal rules for ethics taught in medical school. It means that it may be better not to do something than to do something that carries the risk of harm to the patient but a less certain chance of benefit. Preventing harms associated with the delivery of health care whenever possible is essential to improving patient safety and patient experience.
Unfortunately, low-value health care services can cause harm. Low-value health care, also called overuse or waste, refers to medical tests and procedures that have been shown to provide little benefit in particular clinical scenarios and in many cases have the potential to cause physical, emotional, or financial harm to patients. While harm is not intentional, it is particularly troublesome when it results from tests, procedures, and treatments that were unnecessary.
A new report from the Washington Health Alliance, “First, Do No Harm: Calculating Health Care Waste in Washington State” utilizes the new MedInsight Health Waste Calculator from the actuarial consulting firm Milliman, to produce an analysis of low-value health care services across the state.
In a commentary in the Puget Sound Business Journal Nancy Giunto and Steve Mullin, respectively executive director of the WHA and president of the Washington Roundtable, write,
An extra test might not seem like a big deal — it might even feel like the right thing to do. But unnecessary tests can do more harm than good, costing us all in the long run.
In Washington state, a striking percentage of health care services performed aren’t actually needed — not even to be on the safe side. A handful of procedures in particular, such as headache imaging and tests before low-risk surgery, waste hundreds of millions of dollars each year.
They cite the above-referenced report, which
… looked at 47 common treatment approaches known by the medical community to be overused.
The quick takeaway: Of the estimated $785 million spent on these 47 services in Washington state, approximately $282 million was judged unnecessary. More than one-third of the money spent was wasted.
Overuse must become central to honest discussions of health care value.
Clinical leaders must take up the mantle and lead provider efforts to incorporate reductions of overuse into local practice cultures.
The concepts of “choosing wisely” and shared decision-making must become the bedrock of provider-patient communications.
We need to transform from paying for volume to paying for value in health care.
Provider contracts must include ways to measure overuse, and not just measures of access and underuse of evidence-based care.
The Everett Herald editorial board writes,
The results of its “Do No Harm” report are stark.
An analysis of insurance claims for 1.3 million patients in the state in 2015-16 found that nearly half, 47.9 percent, received treatment that was medically unnecessary or of “low value,” totaling more than $282 million in wasteful spending on care for 622,000 patients in the state.
The preferred term among medical professionals may be “low value,” but Dr. Albert Fisk, chief medical officer for The Everett Clinic and a health alliance board member is more blunt: “It is waste,” he said during a meeting with alliance officials and the editorial board last week, and it should prompt reconsideration of the tests and procedures that are ordered among all concerned, including patients.
The editorial cites the costs and the public policy implications, noting that their are also implications for how individuals approach their own health care decisions.
Advocates among health care professionals and insurers have long called for a transition from paying by volume of individual services to a system that pays providers for health outcomes. The report recommends continuing that transition, but also encourages stakeholders to talk honestly about the waste in the system and take action to measure and reduce waste.
But there’s responsibility for patients too. The alliance report recommends consumers ask themselves and their health care providers five questions:
Do I really need this test or procedure?
What are the risks and side effects?
Are there simpler, safer options?
What happens if I don’t do anything?
How much does it cost, and what does my insurance cover?
As lawmakers at the state and federal level continue their debate as to how best to ensure health care coverage and delivery to Americans, there are steps that must be taken that will make that health care more affordable and responsive to the needs of patients.
We commend the alliance for its report and recommend it to you.