Can’t Get No Satisfaction in Low-Value Medical Care

There’s a lot of finger pointing in healthcare, and most of it, historically, is by hospitals and doctors pointing at everything but themselves for less than optimum, high-priced and hard to access care.

When it comes to the problem of low-value care, one of the things hospitals and doctors like to point at are patients. Low-value care is care that offers little or no therapeutic value to patients and may, in fact, be harmful. Despite ongoing efforts like the Choosing Wisely initiative, low-value care is prevalent in the U.S.  So much so that the Lown Institute has enough data to build and release a ranking of the 50 best and 50 worst hospitals at avoiding low-value care.  

Hospitals and doctors say patients and perverse financial incentives that reward patient satisfaction are to blame for low-value care being as difficult to get rid of as dandelions. Patients, as the argument goes, want their hospitals and doctors to order and perform all kinds of diagnostic tests and prescribe all kinds of medications to find out what’s wrong with them and fix it. More tests equal happier patients.

Payers like Medicare, meanwhile, reward hospitals and doctors for higher patient satisfaction scores and penalize them for lower patient satisfaction scores. Happier patients equal higher reimbursement rates.

Better to give a patient a useless antibiotic, make them happy and get five stars than deny the patient a useless antibiotic, tick them off and get no stars.

Well, a new study in JAMA Internal Medicine basically says that argument doesn’t hold water. You can download the study here. 

Researchers from the universities of Chicago, Harvard and Pennsylvania wanted to know if there was a connection between the provision of low-value medical services and the patient satisfaction scores from the patients who received those medical services. 

To find out, the researchers looked at a random sample of fee-for-service medical claims from Medicare beneficiaries from 2007 through 2014 for eight low-value medical services. The services included things like cervical cancer screenings for older female patients and brain MRI scans for simple headaches.

The researchers married those claims up with 2010 through 2015 patient experience data from about 100,000 primary-care providers who cared for an average of about 260 patients each. The researchers culled the patient experience data from the well-known Consumer Assessment of Healthcare Providers and Systems, or CAHPS, survey completed by the patients. They focused on nine survey items, including timely access to nonurgent care and overall rating of the patient’s physicians. 

To make a long, statistical analysis story short, the researchers found no association between more low-value medical care and better patient satisfaction scores. Further, patients didn’t rate their providers any worse when they got low-value care. 

“Knowing this may help reduce the use of low-value care that is provided to appease patients who would be equally satisfied with less wasteful care and help alleviate concerns that patient dissatisfaction should inhibit waste reduction under alternative payment models,” the researcher concluded.

What the researchers didn’t say is what we all know, and that’s the real problem here is fee-for-service medicine. Hospitals and doctors don’t hesitate to provide low-value care because there’s no incentive not to think twice about it. Every test, procedure and prescription generates revenue.

If you want to curtail low-value care, stop paying for it. As this new study suggests, it won’t affect how patients feel about their hospitals and their doctors.  

As we like to say at 4sight Health, you get the healthcare that you pay for. If we want more value for patients, we need to change the way we pay for care. It’s not that complicated.

Thanks for reading. 

To learn more about this topic, please read the following blog posts and commentaries on 4sighthealth.com:

• “Reducing Low-Value Care Gets Personal” 
• “Shining a Light on the High Risks of Low-Value Care” 
• “How Fee For Service Makes Doctors Choose Poorly” 
• “Now Is the Time to Nip Low-Value Care in the Bud” 
• “Digging Deep (Into Your Own Pockets) to Root Out Low-Value Care”