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'Low-value Care' More Prevalent in Hospital-based Primary Care Practices

By John Commins  
   April 11, 2017

The use of low-value care was common among patients who saw someone other than their primary care physician at a hospital-based primary care practice. Practice location, rather than practice ownership, is the driving factor behind the disparity.

A study in this week's issue of  JAMA Internal Medicine finds that hospital-based primary care practices are more likely to make referrals to specialists and order expensive imaging and other unneeded tests for patients with common conditions than do their colleagues in community-based practices.

Practice location, rather than practice ownership, is the driving factor behind the disparity.


Low-value Care Misunderstood By Patients


The use of low-value care was even more common among patients who saw someone other than their primary care physician at a hospital-based primary care practice.

Study senior author Bruce Landon, MD, a general internist and Harvard Medical School professor of healthcare policy and of medicine at Beth Israel Deaconess Medical Center, spoke with HealthLeaders about the study. The following is a lightly edited transcript.

HLM: Do you believe your findings represent an accurate reflection of what is occurring nationally in the healthcare delivery system?

Landon: These findings might not apply to a particular physician or visit. But we can say that across a very large nationally representative sample of visits, on average, primary care visits to hospital-based vs. community-based visits for these three common conditions resulted in more over use of these lower-value services at hospital-located clinics than in community-based practices.


Unwise Medical Choices Stubbornly Defy Eradication



There are some relatively straightforward reasons for those findings. For example, there is much more readily available imaging equipment in hospitals. In the hospital-based practice where I work there is a CT Scan and an MRI one floor down. If I want to order just a plain film, it's a click of a button.

More commonly, in community-based practices, the patient will have to get in his car and go to an imaging center or a hospital and that is one more hurdle. I'm in a hospital-based practice that has seven floors of specialists. It's probably just easier and more readily available for me to involve specialist colleagues.

Of course, a lesson from this is that clinicians and managers and those who are practicing in hospital-based practices need to be at the very least aware of these tendencies, whether it's through data, feedback, measurements, education, etc., to try to make it so that physicians actually think twice before using these lower-value services that are easily accessible to them.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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