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Q&A: Overuse And Quality Improvement Efforts

posted by Alicia Caramenico

on April 13, 2016

Together the American College of Physicians (ACP) and America’s Health Insurance Plans (AHIP) conducted a study to illustrate the magnitude and trends in potential overuse of three health care services. We spoke to ACP Executive Vice President & CEO Steve Weinberger and AHIP’s Senior Vice President of Private Market Innovations and Director of the Center for Policy and Research Aparna Higgins to learn more about the analysis and what its findings can teach us about improving the quality and safety of health care.

Why did you conduct this study?

Aparna Higgins: As we move towards delivery system reform and care that is more patient-centered, it is important to eliminate unnecessary services in order to improve the overall quality of care and safety for patients while reducing wasteful spending. The American College of Physicians’ High Value Care Initiative and the Choosing Wisely campaign helped bring national spotlight to this issue of overuse. Our member health plans and ACP were interested in understanding the magnitude and trends in overuse of specific services. Such an understanding can help us better focus quality improvement efforts.

What role do clinical guidelines and decision support tools play in reducing overuse?

Steve Weinberger: Physicians and health plans rely on evidence-based clinical guidelines to ensure appropriate care is being delivered to patients. Clinical guidelines that clearly identify the appropriate use of frequently overused tests and procedures, including such recommendations as when to start and stop testing, would go a long way in reducing unnecessary medical services. In a similar sense, decision support tools would help in reducing unnecessary services by enabling clinicians to readily obtain information and recommendations at the point of care. For example, the Institute for Clinical Systems Improvement developed decision-support tools to help clinicians appropriately order high-tech imaging studies. Health plans and providers implementing these tools saw reductions in inappropriate use of high-tech imaging.

What factors do you believe are contributing to the decline in overuse that you observed? 

Higgins: There could be many different factors at play here, but we recognize that health plans’ efforts in promoting evidence-based medicine, and initiatives like the Choosing Wisely campaign and the American College of Physicians’ High Value Care Initiative, are likely contributing to a clearer understanding by clinicians of when it is appropriate to use certain tests and procedures.

How would eliminating overuse of health care services affect patients and the overall health care system? 

Weinberger: From a patient point of view, eliminating inappropriate use of services helps improve quality and safety. Examples include reduced radiation exposure, as well as fewer follow-up tests and even surgeries that could result from false positive tests. All of these types of change can raise the level of care for patients and improve their overall quality of life by eliminating unnecessary time spent in a doctor’s office or hospital and reducing patient anxiety. Another impact of eliminating overuse of services is reduction in wasteful spending. In 2009, The Institute of Medicine estimated that 30% of all national healthcare spending was wasted and that 27 percent of this wasteful spending could be attributed to provision of unnecessary services. Eliminating the overuse of health care services could significantly decrease wasteful spending, and can help make health care more affordable for consumers.

To read the full study, click here.