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April 8, 2021

Reducing Low-Value Care and Improving Health Care Value

Author Affiliations
  • 1Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 2Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA. 2021;325(17):1715-1716. doi:10.1001/jama.2021.3308

Low-value care, defined as the use of a health service for which the harms or costs outweigh the benefits, is a pervasive and enduring problem in the US. Enacting policies that limit reimbursement for low-value services is an important step in mitigating such care. For example, Powers et al1 proposed a framework to identify and prioritize policies to govern the de-adoption of low-value care focused on evidence, eminence, and economics. However, transitioning to a state of health care delivery that prioritizes value over volume will require balancing “top-down” policy prescriptions with a “bottom-up” approach geared toward affecting local cultural change. Such an approach involves implementing de-adoption strategies tailored to address the behavioral and organizational factors that drive the provision of low-value care within a local health care ecosystem, whether it is an individual practice or a tertiary referral center.

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    2 Comments for this article
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    Reducing Low Value Care
    Karl Stecher, AB Harvard, MD Maryland | Neurosurgeon, retired
    Quality of care has few reliable measures. Doctors who have been victims of a medical malpractice lawsuit, with barbs such as "You could have done that test, couldn't you, doctor?" might disagree with the notion that low value tests can be eliminated.
    CONFLICT OF INTEREST: None Reported
    One Easy Fix to Reduce Negative Value Care: Update American College of Radiology Mammogram Screening Guidelines
    Florence LeCraw, M.D. | Andrew Young School of Policy Studies, GA State Univ
    Unlike the USPSTF, ACP, & ACS mammogram screening guidelines, the American College of Radiology recommends annual mammogram screening for women with no breast cancer risk factors from age 40 until death. Per studies by well respected biostatisticians, using ACR mammogram screening guidelines results in more patients hurt than helped. Unfortunately, 85% of U.S. physicians and a majority of U.S. breast cancer centers follow ACR guidelines. Many members of ACR are concerned that this practice guideline is detrimental to their patients' health and the public good due to wasteful healthcare spending. Fear of malpractice claims does not justify the negative impact of over screening recommended by the ACR. I encourage ACR leaders to reevaluate their mammogram screening guidelines using experts in the field of epidemiology, econometrics, and biostatistics.
    CONFLICT OF INTEREST: None Reported
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