Investigators at Stanford University Describe Findings in Information Technology (Is Low-value Testing Before Low-risk Hand Surgery Associated With Increased Downstream Healthcare Use and Reimbursements? a National Claims Database Analysis): Information Technology

2022 OCT 14 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Current study results on Information Technology have been published. According to news reporting out of Redwood City, California, by NewsRx editors, research stated, “Minor hand procedures can often be completed in the office without any laboratory testing. Preoperative screening tests before minor hand procedures are unnecessary and considered low value because they can lead to preventable invasive confirmatory tests and/or procedures.”

Funders for this research include Orthopaedic Research and Education Foundation Mentored Clinician Scientist Grant, National Institutes of Health (NIH) - USA.

Our news journalists obtained a quote from the research from Stanford University, “Prior studies have shown that low-value testing before low-risk hand surgery is still common, yet little is known about their downstream effects and associated costs. Assessing these downstream events can elucidate the consequences of obtaining a low-value test and inform context-specific interventions to reduce their use. Questions/purposes (1) Among healthy adults undergoing low-risk hand surgery, are patients who receive a preoperative low-value test more likely to have subsequent diagnostic tests and procedures than those who do not receive a low-value test? (2) What is the increased 90-day reimbursement associated with subsequent diagnostic tests and procedures in patients who received a low-value test compared with those who did not? Methods In this retrospective, comparative study using a large national database, we queried a large health insurance provider’s administrative claims data to identify adult patients undergoing low-risk hand surgery (carpal tunnel release, trigger finger release, Dupuytren fasciectomy, de Quervain release, thumb carpometacarpal arthroplasty, wrist ganglion cyst, or mass excision) between 2011 and 2017. This database was selected for its ability to track patient claims longitudinally with direct provision of reimbursement data in a large, geographically diverse patient population. Patients who received at least one preoperative low-value test, including complete blood count, basic metabolic panel, electrocardiogram, chest radiography, pulmonary function test, and urinalysis within the 30-day preoperative period, were matched with propensity scores to those who did not. Among the 73,112 patients who met our inclusion criteria (mean age 57 +/- 14 years; 68% [49,847] were women), 27% (19,453) received at least one preoperative low-value test and were propensity score-matched to those who did not. Multivariable regression analyses were performed to assess the frequency and reimbursements of subsequent diagnostic tests and procedures in the 90 days after surgery while controlling for potentially confounding variables such as age, sex, comorbidities, and baseline healthcare use. When controlling for covariates such as age, sex, comorbidities, and baseline healthcare use, patients in the low-value test cohort had an adjusted odds ratio of 1.57 (95% confidence interval [CI] 1.50 to 1.64; p< 0.001) for a postoperative use event (a downstream diagnostic test or procedure) compared with those who did not have a low-value test. The median (IQR) per-patient reimbursements associated with downstream utilization events in patients who received a low-value test was USD 231.97 (64.37 to 1138.84), and those who did not receive a low-value test had a median of USD 191.52 (57.1 to 899.42) (adjusted difference when controlling for covariates: USD 217.27 per patient [95% CI 59.51 to 375.03]; p = 0.007). After adjusting for inflation, total additional reimbursements for patients in the low-value test cohort increased annually. Low-value tests generate downstream tests and procedures that are known to provide minimal benefit to healthy patients and may expose patients to potential harms associated with subsequent, unnecessary invasive tests and procedures in response to false positives. Nevertheless, low-value testing remains common and the rising trend in low-value test-associated spending demonstrates the need for multicomponent interventions that target change at both the payer and health system level. Such interventions should disincentivize the initial low-value test and the cascade that may follow.”

According to the news editors, the research concluded: “Future work to identify the barriers and facilitators to reduce low-value testing in hand surgery can inform the development and revision of deimplementation strategies.”

This research has been peer-reviewed.

For more information on this research see: Is Low-value Testing Before Low-risk Hand Surgery Associated With Increased Downstream Healthcare Use and Reimbursements? a National Claims Database Analysis. Clinical Orthopaedics and Related Research, 2022;480(10):1851-1862. Clinical Orthopaedics and Related Research can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.

Our news journalists report that additional information may be obtained by contacting Robin N. Kamal, Stanford University, Voices Hlth Policy Res Ctr, Dept. of Orthopedic Surgery, 450 Broadway St, Mc 6342, Redwood City, CA 94603, United States. Additional authors for this research include Jessica M. Welch, Thompson Zhuang, Alex H. S. Harris, Lauren M. Shapiro and Laurence C. Baker.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1097/CORR.0000000000002255. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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