As reducing unnecessary care becomes increasingly important in a value-based care environment, healthcare providers must take action--and stop making excuses, according to a post from consulting firm Navigant.
Despite the high cost of unnecessary care, reducing it is a challenge for healthcare providers. For one thing, the post notes, there is so much clinical evidence and data that it's difficult to sort through it to find what works and what doesn't. Meanwhile, the existing evidence for effective practices for complex cases, such as patients with co-morbidities, is often weak.
"These views provide a defensible rationale as to why medical necessity and unnecessary care is a systemic challenge in our system, but in coming months, they may be seen more as lame excuses," Paul Keckley, managing director of the Navigant Center for Healthcare Research and Policy Analysis, writes in the post.
Keckley lists several keys to reducing unnecessary care, including:
Increased documentation: Accurately documenting the care process across various sites and care systems is vital to reducing unnecessary care.
More transparent data: As performance data for physicians, hospitals and health systems becomes increasingly available and accessible, transparency on both medical necessity and unnecessary care is a certainty.
Bigger payments and penalties: Enforcement of penalties is likely to rise, and both payers and enforcement institutions will likely scrutinize newer healthcare models, such as bundled payments and accountable care organizations, to reduce unnecessary care.
Greater physician leadership: Efforts to reduce unnecessary care will increase the role and scope of the chief clinical officer. CCOs will have more complicated duties, rely more on clinical data and in some cases be more at odds with their peers within the organization than they were in the past.
A 2014 survey from Choosing Wisely found 75 percent of doctors think their peers order unnecessary tests and procedures, FierceHealthcare previously reported. "I think we're afraid of not being liked," said Donald Ford, M.D., a vice president at Hillcrest Hospital in Mayfield Heights, Ohio. "We want to be the hero to the patient."
To learn more:
- here's the post