System-level factors influence doctors to reduce low-value care practices

System-level factors influence doctors to reduce low-value care practices

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1456    

Editorial: https://www.acpjournals.org/doi/10.7326/M24-0862  

URL goes live when the embargo lifts     

A study analyzing Medicare data on low-value care (LVC) services, or services that provide little to no benefit relative to their potential cost, found that physicians were more strongly influenced by system-level factors that encourage a reduction of LVC and more resistant to factors that encourage an increase in LVC. In other words, physicians moving to locations with lower rates of LVC were more likely to adopt those practices, but the opposite was not true. The findings are published in Annals of Internal Medicine.  

Researchers from the University of Utah studied Medicare claims data for matched physician-patient groups comprised of 8,254 physicians and 56,467 patients for two services that can have low value—prostate-specific antigen (PSA) testing and mammography screening—in fee-for-service Medicare beneficiaries aged 75 years or older. The goal was to determine if system-level factors would influence LVC. The researchers compared LVC rates for physicians staying in their original service area and those relocating to new areas. They found that physicians who relocated to a new service area with lower rates of LVC started to practice more like physicians in that new area. Further, the researchers observed a dose–response effect in which physicians who relocated from high- to medium-LVC areas provided more LVC than those who relocated to low-LVC areas but less than those who stayed in high-LVC areas. The authors note that this pattern was not noticed among physicians relocating from low- to higher-LVC areas.  

The authors of an accompanying editorial from Dartmouth College and Brigham and Women’s Hospital say that if there are ways to both reduce spending and improve quality of care and patient experience, they should be quickly adopted. The study shows what might happen when physicians assimilate in a new environment and highlights the complex interplay among system, clinician, and patient factors in LVC use and solutions. 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author, Kassandra Dindinger-Hill, BS, please email [email protected].