Investor-owned health systems and those with fewer PCPs linked to more low-value care
Investor-owned health systems and those with fewer primary care physicians are associated with performing a higher amount of wasteful healthcare services, according to new data published Friday.
Integrated healthcare delivery systems, such as Kaiser Permanente, were found to provide more high-value services, along with University of Utah Hospitals and Intermountain Healthcare, which are known to focus on higher-value care.
At the same time, organizations in highly competitive markets, including UPMC and Allegheny Health Network, were associated with overusing low-value care, experts reported Friday in JAMA Health Forum.
Policy experts based their findings on a novel “overuse index,” which traced the utilization of 17 low-value services across more than 675 health systems in the U.S. It’s a new approach to measure health waste that the authors believe should be utilized going forward.
“The findings of this cross-sectional analysis of Medicare beneficiaries and U.S. health systems suggest that the overuse index with its publicly available code should be valuable to health systems and be a valuable tool for health services researchers interested in further investigation of drivers of overuse and evaluation of interventions to reduce these harmful practices,” Jodi B. Segal, MD, MPH, with Johns Hopkins University School of Medicine, and colleagues with the Baltimore-based university’s policy school added.
The team relied on a previous overuse index that incorporated billing codes to reflect the use of low-value care compared to other regions but updated it to include ICD-10 codes for Medicare beneficiaries with claims dating from 2016-2018.
The total cohort included 3,745 hospitals linked to 676 health systems and factored in legacy low-value services such as MRI lumbar spine for low back pain and nasal endoscopy for diagnosing sinusitis along with new procedures including advanced imaging for acute foot trauma and screening mammography for women 80 and older.
The findings align with prior research showing that the number of physicians and investor ownership are each associated with providing more low-value care. This study, like others, also found no association between overuse and health systems that own insurance plans and/or utilize accountable care organizations, the authors explained.
The group did note that factors such as serving as a safety-net hospital and being under-resourced have a role in their findings. Segal and colleagues are planning to dive deeper into the numbers.
“We strongly suspect that the practice patterns in the hospital and its clinics sets the practice patterns for the whole system, and we look forward to exploring this more with qualitative work,” the authors concluded.
Read more from the authors in the full study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.