Doctors Wasting Millions On Low-Value Services, Study Says

Despite efforts by the healthcare industry to cut back on low-value services, doctors continue to waste millions of dollars on them and new research suggests it could be linked to specific patients and types of insurance.

About 8 percent of patients received a low-value healthcare service in 2015, with most being white and having more expensive insurance plans, suggesting the perceived overuse of certain procedures and tests has more to do with money than with the best care option for patients, according to a study published in the journal JAMA Internal Medicine.

Previous research has estimated more than $750 billion of healthcare spending in the United States is wasteful, which is just under one-third of the $2.5 trillion Americans spend on healthcare each year.

For the new study, researchers at the Rand Corporation looked at spending on 28 low-value healthcare services using a 25 percent random sample of commercial claims from the Optum Clinformatics Datamart of UnitedHealthcare collected between 2011 and 2013, counting the number of unique patients receiving each service and establishing standardized costs for each of them.

Overall, the researchers found 7.8 percent of the 1.46 million patients' records examined had received a low-value service in 2013, total about $32.8 million, or 0.5 percent of total healthcare spending that year.

The most common services, researchers reported, were triiodothyronine measurement in hypothyroidism, imaging for nonspecific low back pain and imaging for uncomplicated headache. The biggest proportion of spending was on spinal injections for lower back pain, head imaging for uncomplicated headache and imaging for nonspecific low back pain.

The researchers also report low-value spending was lower among nonwhite and lower-income patients, showing underuse of the procedures among less advantaged groups of patients and overuse among more advantaged groups.

The study suggests a problem similar to one leading the Centers for Medicare and Medicaid Services to start testing new methods of prescription reimbursement to drive doctors toward less expensive, but just as effective, options.

Limiting the use of procedures without much benefit, such as imaging for non-specific low back pain or uncomplicated headaches, is seen as a key to driving down the overall cost of healthcare.

Researchers point to efforts like the American Board of Internal Medicine's Choosing Wisely campaign, which offers doctors and patients lists of procedures seen as less likely to help improve health, as a move in the right direction -- but the new study suggests this is not happening.

In an editorial published by JAMA Internal Medicine with the new study, Dr. Anna Parks and Dr. Patrick O'Malley suggest the issue may not come down simply to making more money, but to a lack of information among doctors and clinicians who may not have easy access to information.

Parks and O'Malley also suggest doctors work harder to explain to patients what they are or are not doing and why.

"As we strive to curb overuse, one area ripe for intervention may be how we communicate with patients about medical decisions, particularly those related to low-value care," Parks and O'Malley wrote in the editorial. "Both trainees and practicing clinicians appear to lack adequate skill in accurately discussing the risks and benefits of care in a shared manner."

Whether the problem is lack of knowledge and communication, or just about money, Dr. Rachel Reid, a researcher at Rand Corporation and lead author of the new study, told CNN the study was just scratching the surface.

"The important caveat to highlight is, we're only looking at 28 services," Reid said. "We're looking at a very small slice, but it can give you a lens on the larger problem."