Low-value care most common among systems with fewer primary care physicians, investor ownership

High bed counts, few primary care physicians and investor ownership are common themes among health systems frequently delivering low- or no-value medical services, according to a recent analysis. 

Health systems that had a greater number of medical groups were also associated with healthcare overuse, per the study based on a Johns Hopkins analysis of 676 U.S. health systems, while those with teaching hospitals or a greater burden of uncompensated care were less likely to deliver the cost-driving procedures.

“Overuse of health care, or the provision of low-value or no-value care, is consistently identified as contributing to high costs in the US health care system,” the researchers wrote in JAMA Health Forum. “This wasteful care is physically, psychologically and financially harmful to patients.”

The study tallied Medicare claims from 2016 to 2018 for 17 procedures that have limited clinical support, such as an MRI of the lumbar spine for low back pain or a Pap smear for women aged 65 years and older.

Alongside identifying specific features associated with overuse among their sample of 3,745 non-pediatric hospitals, the Johns Hopkins team sought to update a tool called the Overuse Index that policy researchers and others can use to measure systems delivering these procedures well above or below the industrywide average.

RELATED: Southern and for-profit hospitals more frequently deliver unnecessary tests and procedures: analysis

Per the study, the researchers named St. Dominic Health Services in Jackson, Mississippi; USMD Health System in Irving, Texas; Community Medical Centers in Clovis, California; and Care New England Health System in Providence, Rhode Island, among the country’s worst offenders in contributing to healthcare overuse.

Topping the other end of the spectrum was ArchCare in New York, New York; Ozarks Community Hospital Health System in Springfield, Missouri; NYC Health + Hospitals in New York, New York; NuHealth in East Meadow, New York; and Grady Health System in Atlanta.

Among the country’s largest for-profit health systems, Tenet Healthcare, HCA Healthcare, Community Health Systems and Universal Health Services were each above the industry mean by less than a single standard deviation.

Among major nonprofits, Trinity Health, Cleveland Clinic, Mayo Clinic and Kaiser Permanente were all below the industrywide mean to varying degrees, while Intermountain Healthcare, Ascension Health, UPMC and Providence Saint Joseph Health scored above average on the researchers’ Overuse Index.

Medically unnecessary care has proven itself to be a costly issue for the healthcare industry, with a 2019 study estimating that overuse in the U.S. contributes to somewhere between $75 billion and $100 billion in wasted spending.

Another Medicare claims analysis headed by the Lown Institute and published in JAMA Network Open last year identified more than 1.3 million low-value tests and procedures delivered by 3,351 hospitals between 2015 and 2017. That study also suggested overuse was most common among for-profit hospitals, nonteaching hospitals and those located in the southern U.S.