Reducing overuse of 28 low-value services such as spinal injections and imaging for non-specific head and lower-back pain could lower overall healthcare spending and improve quality, a RAND study suggests.
A research letter out this week in JAMA Internal Medicine suggests that considerable savings could be generated by reducing the use of a wide array of low-value health services among adults with commercial health insurance.
The study by researchers from the RAND Corp. and the University of Southern California examined insurance claims from more than 1.46 million adults from across the nation and found that spending on 28 low-value medical services totaled $32.8 million during 2013 within the group. That accounted for 0.5% of total spending or more than $22 per person annually.
"Our findings add evidence to the notion that reducing overuse of medical procedures could improve quality while reducing spending," said Rachel Reid, MD, lead author of the study and a RAND researcher.
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Researchers examined medical services that experts have agreed provide little value to patients given the cost and available alternatives. The greatest proportion of spending for low-value services was for spinal injection for lower-back pain at $12.1 million, imaging for uncomplicated headache at $3.6 million and imaging for nonspecific low-back pain at $3.1 million.
By some estimates about $200 billion in healthcare spending nationally is for overtreatment. To reduce that amount, the American Board of Internal Medicine Foundation and consumer groups launched the Choosing Wisely campaign in 2012 to encourage physicians and patients to talk about evidence-based medicine.
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"The services in this study reflect many clinical areas and types of care, but still are a small portion of all the low-value care patients receive," Reid said. "The potential savings from reducing these low-value services and others are substantial."
'Disparities in healthcare Cut Two Ways'
The analysis of 28 low-value procedures found that 7.8% of the patients studied received low-value services in 2013. Low-value spending was lower among patients who were older, male, black or Asian, lower-income or enrolled on consumer-directed health plans, which have high member cost-sharing.
"Disparities in healthcare cut two ways. [They] can cause poor access to high-value care among vulnerable patients and overuse of low-value care among more-advantaged groups. Both need attention," said Neeraj Sood, senior author of the study and director of research at the Leonard D. Schaeffer Center for Health Policy at USC.
Researchers say that among the issues that should be better understood before interventions are created to reduce the use of low-value are why more-advantaged groups receive more of the care and whether people in consumer-directed health plans also had lower levels of high-value healthcare.
Choosing Wisely Lists Too Meek?
While previous studies of low-value medical care have focused on Medicare recipients or narrower regions, the RAND/USC study evaluated the care received by a large group of nonelderly adults insured through one of the nation's largest commercial health insurance companies. Regionally, the Southern, Middle Atlantic and Mountain regions had proportionately more low-value spending.
"Areas with high Medicare spending also seem to have greater use of low-value services among those with commercial insurance," Sood said. "This confirms that there are opportunities for cost savings, and that both private insurers and Medicare can benefit from efforts to reduce use of low-value care."