VBID Summit: Removing Low-Value Care From the Healthcare System

Low-value care can harm consumers in more than 1 way. There is the financial harm that results from paying for unnecessary services, but there is also the risk of unnecessary physical harm from a medical procedure they didn’t need to receive, said Lynn Quincy, director of the Healthcare Value Hub at Consumers Union, the policy and advocacy division of Consumer Reports.

Quincy spoke on a panel on addressing low-value care at the end of the day-long VBID Summit, hosted by University of Michigan’s Center for Value-Based Insurance Design (VBID).

William A. Hazel Jr, MD, secretary of Health and Human Resources for the Commonwealth of Virginia, added that there is a lot of waste in the healthcare system, and removing that waste might mean the country can start to deal with other pressing situations, such as treating patients with addiction or mental health issues.

The third panelist was Daniel Wolfson, the executive vice president and chief operating officer of the ABIM Foundation, which is responsible for the Choosing Wisely campaign, which promotes conversations between physicians and patients about utilizing appropriate tests and treatments and avoiding unnecessary care.

There are services that are the result of demand and supply, Wolfson said, such as treatment for lower back pain. However, there are others that take place in the hospital or when a patient is in critical care and the patient won’t be demanding services there. Each of these situations need to be viewed differently because what works for one might not work for another.

On the patient side, Consumer Reports has released 5 questions that patients should ask, such as, “Do I really need this test?” However, the ideal situation would be for low-value care to be out of the system completely so consumers don’t have to negotiate their care, Quincy said.

“What consumers really want is for the system to work for them without doing anything,” she said. “When they go to consume healthcare, they want to go and know there isn’t a misstep they can make.”

On the physician side, the ABIM Foundation helped to develop modules for how providers should handle a patient demanding a service that is low value.

Unfortunately, physicians do get pushed by patients for unneeded services, Hazel said. He added that people come into the emergency room demanding some service, and in the age of consumerism, physicians end up going along with it. “It is very difficult,” he said.

Hazel pointed out the demand for pain management as the perfect example of something where the public had demanded pain medication, but there was evidence suggesting it was dangerous.

What is required is a behavioral change in healthcare that will not happen through education alone, Wolfson said. When there are people who have been practicing medicine the same way for 30 years, they won’t suddenly want to change. In addition, as of right now, Choosing Wisely is not known by every physician. According to Wolfson, the Foundation sees just over a 60% awareness rate.

A big barrier in place, though, is that the healthcare system is “holding onto fee-for-service for dear life,” Wolfson said. And for hospitals that are fully in fee-for-service, it would be “economically foolish” to follow Choosing Wisely.

To close out the discussion, each panelist provided 1 thing that could be used to help reduce low-value services. Wolfson identified the need for breakthroughs in implementation techniques to propel the Choosing Wisely movement along.

Quincy voiced a desire for a better way to understand where low-value care is being provided through the use of public data systems that are robust enough to allow for comparison reports.

Finally, Hazel noted that while education is needed, the move to reduce low-value services has to be backed up by the fiscal reality. In order for it to be successful, it can’t just be the doctors or just the consumers pushing for the reduction, there needs to be a symbiosis between the 2 groups.