ACP: Performance Measures for 'Low-Value' Services Needed

Performance measures targeting services that provide little value for patients have the potential to help control health care costs by changing physicians’ behavior through feedback and possible financial incentives, according to a policy paper from the American College of Physicians published Oct. 30 in Annals of Internal Medicine.

To date, performance measurement data mainly have been used to encourage physicians to provide more high-value services, such as immunizations and medications for chronic diseases. But measures for low-value services could prove equally valuable.

"The first step in addressing the high cost of health care should be decreasing use of interventions that provide no or very little benefit and are of low value," according to the policy paper. "For example, at the same time that we should be measuring the proportion of patients age 50 to 75 [years] who have been screened for colorectal cancer, we should be assessing the proportion of patients over the age of 75 who had colorectal cancer screening that was not indicated."

Diagnostic imaging for uncomplicated low back pain is another example of a low-value intervention, the paper noted, because the evidence indicates that the use of routine x-ray or advanced imaging methods does not improve outcomes for patients.

Low-value services include those for which the harms likely exceed the benefits and those that may provide benefits, but for which the tradeoff between benefits and costs is undesirable, the policy paper indicated. There’s no universally accepted "bright line" that defines the point where the tradeoff indicates a service isn’t cost-effective, the authors wrote, adding, "this will ultimately be a societal decision that depends on how much money we are willing to spend on health care, as well as societal priorities."

Measures that target low-value interventions likely will need to be applied at the level of the hospital or the multispecialty group practice because many individual physicians won’t see enough patients with the target conditions.

"In addition, primary care physicians and specialists are often involved in decision making, and both should be held accountable rather than just the person who ordered the test," the paper said.

The policy recommends that performance measures should be based on high-quality evidence that assesses the benefits, risks, and costs of interventions. Like other performance measures, those for low-value services could be used for feedback and public reporting, and to provide financial incentives to change physician behavior, according to the ACP.

Performance measures targeting services that provide little value for patients have the potential to help control health care costs by changing physicians’ behavior through feedback and possible financial incentives, according to a policy paper from the American College of Physicians published Oct. 30 in Annals of Internal Medicine.

To date, performance measurement data mainly have been used to encourage physicians to provide more high-value services, such as immunizations and medications for chronic diseases. But measures for low-value services could prove equally valuable.

"The first step in addressing the high cost of health care should be decreasing use of interventions that provide no or very little benefit and are of low value," according to the policy paper. "For example, at the same time that we should be measuring the proportion of patients age 50 to 75 [years] who have been screened for colorectal cancer, we should be assessing the proportion of patients over the age of 75 who had colorectal cancer screening that was not indicated."

Diagnostic imaging for uncomplicated low back pain is another example of a low-value intervention, the paper noted, because the evidence indicates that the use of routine x-ray or advanced imaging methods does not improve outcomes for patients.

Low-value services include those for which the harms likely exceed the benefits and those that may provide benefits, but for which the tradeoff between benefits and costs is undesirable, the policy paper indicated. There’s no universally accepted "bright line" that defines the point where the tradeoff indicates a service isn’t cost-effective, the authors wrote, adding, "this will ultimately be a societal decision that depends on how much money we are willing to spend on health care, as well as societal priorities."

Measures that target low-value interventions likely will need to be applied at the level of the hospital or the multispecialty group practice because many individual physicians won’t see enough patients with the target conditions.

"In addition, primary care physicians and specialists are often involved in decision making, and both should be held accountable rather than just the person who ordered the test," the paper said.

The policy recommends that performance measures should be based on high-quality evidence that assesses the benefits, risks, and costs of interventions. Like other performance measures, those for low-value services could be used for feedback and public reporting, and to provide financial incentives to change physician behavior, according to the ACP.

Performance measures targeting services that provide little value for patients have the potential to help control health care costs by changing physicians’ behavior through feedback and possible financial incentives, according to a policy paper from the American College of Physicians published Oct. 30 in Annals of Internal Medicine.

To date, performance measurement data mainly have been used to encourage physicians to provide more high-value services, such as immunizations and medications for chronic diseases. But measures for low-value services could prove equally valuable.

"The first step in addressing the high cost of health care should be decreasing use of interventions that provide no or very little benefit and are of low value," according to the policy paper. "For example, at the same time that we should be measuring the proportion of patients age 50 to 75 [years] who have been screened for colorectal cancer, we should be assessing the proportion of patients over the age of 75 who had colorectal cancer screening that was not indicated."

Diagnostic imaging for uncomplicated low back pain is another example of a low-value intervention, the paper noted, because the evidence indicates that the use of routine x-ray or advanced imaging methods does not improve outcomes for patients.

Low-value services include those for which the harms likely exceed the benefits and those that may provide benefits, but for which the tradeoff between benefits and costs is undesirable, the policy paper indicated. There’s no universally accepted "bright line" that defines the point where the tradeoff indicates a service isn’t cost-effective, the authors wrote, adding, "this will ultimately be a societal decision that depends on how much money we are willing to spend on health care, as well as societal priorities."

Measures that target low-value interventions likely will need to be applied at the level of the hospital or the multispecialty group practice because many individual physicians won’t see enough patients with the target conditions.

"In addition, primary care physicians and specialists are often involved in decision making, and both should be held accountable rather than just the person who ordered the test," the paper said.

The policy recommends that performance measures should be based on high-quality evidence that assesses the benefits, risks, and costs of interventions. Like other performance measures, those for low-value services could be used for feedback and public reporting, and to provide financial incentives to change physician behavior, according to the ACP.