A study, published in JAMA Internal Medicine, sought to establish if, as research suggests, that physicians may provide unnecessary or marginally useful services because patients want the services and physicians cater to their wishes. The study results however did not find an association between “low-value” care and higher ratings on a standard survey used to assess patient experience.
Researchers said their findings may reduce the use of low-value care to appease patient and alleviate concerns that the patient experience and satisfaction scores used in value-based care could be counterproductive.
The study was conducted by analyzing Medicare fee for service for eight low-value service, such PSA tests for older men, cervical cancer screening for older women, head imaging for uncomplicated headache. Researchers used that data to create composite measure of exposure to low-value care. For patient experience, they used results from the Consumer Assessment of Healthcare Providers and System (CAHPS) Medicare fee-for-service survey. That survey asks questions about interactions with physicians, such as whether the physician listened carefully to the patient and explained things clearly, as well as about timely access to care and overall rating of the healthcare services the patient has received.
They assessed the association between “exposure” to low-value care and CAHPS results for 100,743 primary care professional (PCP) patient panels that had, on average, 258 patients per panel. For the most part, their analysis did not find a statistical link between exposure to low-value care and a better health experience as measured by CAHPS. But the study also did not find an association between low-value care and a worse health experience as measured by CAPHS, with one exception: long waiting room times were associated with exposure to low-value care. One possible explanation offered by the researchers is that “poorly organized or overwhelmed practices substitute wasteful services for higher-value services that require more cognitive effort and clinician time.”
- Association of Low-Value Care Exposure With Health Care Experience Ratings Among Patient Panels. JAMA Internal Medicine. May 28 2021