Docs, patients struggle to 'choose wisely' in cost-efficient care

Despite national efforts to discourage low-value services, the industry still faces many stumbling blocks toward delivering cost-efficient healthcare, according to an article published this week in the Journal of the American Medical Association.

"The trouble with 'choosing wisely' is that it is not just hard for patients, it is also hard for physicians," senior author David Asch, executive director of the Penn Medicine Center for Innovation, said yesterday in a statement.

University of Pennsylvania researchers looked at the "Choosing Wisely" initiative, in which respected physician groups identified 45 tests and procedures as being overused without necessarily benefiting patients or the healthcare system. However, the researchers question current value-based strategies, citing mixed results.

The researchers also note that cost-sharing strategies are not aligned with evidence-based guidelines. Moreover, testing and treatment guidelines for the Centers for Medicare & Medicaid Services can't consider cost and value.

For example, prostate-specific antigen testing is no longer supported by the U.S. Preventive Services Task Force but is still covered by insurance plans. Such misalignment can thwart physician-patient discussions of whether the benefits of those procedures outweigh the risks, according to the researchers.

The healthcare system itself is partly to blame for physicians and patients choosing low-value services, Medical Economic reported. "The culture has been built around an expectation that providing more medical care is far better than providing less," said Michael LeFevre of the University of Missouri's School of Medicine.

To really get physicians and patients to choose high-quality services, the UPenn researchers suggest incorporating psychology and behavioral economics to help providers better understand how patients make medical decisions.

"That process is quite nuanced, and while insurance benefits can be designed to help steer patients away from low-value care, in many cases, patients will need help from their providers in determining which care falls into that category and why," lead author Kevin Volpp, director of Penn's Center for Health Incentives and Behavioral Economics, said in the research announcement.

Meanwhile, an article in the August Annals of Internal Medicine lauded the "Choosing Wisely" initiative as a means to reduce unnecessary tests, especially inappropriate imaging; 25 of the 45 over-prescribed medical services were related to diagnostic imaging.

To learn more:
- read the UPenn statement
- here's the JAMA article
- read the Medical Economics article