Addressing medical overuse is critical to improving healthcare for patients and providers alike, and DrChrono partner OutcomeMD is spearheading the effort to combat this persistent healthcare issue. Recently, OutcomeMD’s director of content and education, Victoria Hahn, led a webinar with DrChrono breaking down the causes of medical overuse, its effects and the possible solutions to curtail medical overuse in the healthcare industry.
This article will present an overview of the topics covered in the webinar for those looking for more high level coverage, so make sure to watch the full webinar when you have the time. Medical overuse is happening at medical practices all around the country, and ultimately, it does not really serve patients or the providers who are doing it. Before learning how to solve this problem, we need a clear idea of what we are dealing with.
What is medical overuse?
Medical overuse occurs when providers are over-delivering tests and procedures to patients for little to no benefit. As with anything, medical interventions can have diminishing returns when not applied purposefully. Overuse of healthcare resources can be costly for patients and providers without improving health outcomes when all is said and done. Research has also determined four main categories of medical overuse. The first category is over-testing, then over-diagnosis, over-treatment and finally, services to question.
What are the effects of medical overuse?
One of many ways in which medical overuse proves to be counterintuitive for providers is that it ends up wasting money and resources. Victoria Hahn explains this through some research findings by the Institute of Medicine.
“The Institute of Medicine in 2013 stated that 28% of the estimated $750 billion in excess spending each year could be attributed to unnecessary healthcare services,” said Hahn.
Those numbers prove that this is a longstanding and costly issue in healthcare. Worse yet, these are costs that generally do not translate into better health outcomes.
“One example of this is reported by Sadigh et al. They examined around 35,000 female Medicare beneficiaries with advanced colorectal or lung cancer. Although breast cancer screening in advanced cancer patients with life expectancy of less than five to seven years is generally not recommended, 9% of these women with advanced cancer were screened and 11% of those who were screened received at least one additional downstream test,” Hahn explained. That equates to thousands of women receiving unnecessary medical tests during an immensely stressful time in their lives. Tests like this, in many cases, only prove to waste money and time for all involved.
As established, medical overuse hurts your bottom line, but more importantly, it hurts your patients. The goal of every physician is to improve their patient’s condition, and sometimes practical healthcare resource usage gets lost in that effort. Unfortunately, that can lead to net neutral or negative outcomes for patients.
“There was a meta-analysis of randomized control trials of non-pregnant adults with subclinical hypothyroidism receiving thyroid hormone therapy. They found that the mean thyrotropin levels were normalized by the end of the follow-up period in the treatment group, as opposed to the placebo or no treatment group where those levels remained elevated. However, thyroid hormone therapy was, crucially, not associated with benefit for either of the two primary outcomes, which were quality of life and thyroid related symptoms,” Hahn explained in her presentation.
Patients trust their providers to help them achieve desired health outcomes, and providers are constantly doing everything in their power to make that happen. Still, more thoughtful usage of healthcare resources can be the best path to those goals.
Healthcare providers want to give their patients the best care possible, so when faced with having to deliver extraneous tests and procedures, it can take a toll on their psyche as well. This can compound over time into burnout for these providers.
“Chamberlain et al conducted a cross-sectional, self-administered questionnaire to clinicians. They found that of the 349 clinicians surveyed, 79% of them had provided futile or potentially inappropriate care (PIC) in the past six months. Providing these futile services is associated with avoidant and compensatory behaviors, and ultimately these behaviors were associated with burnout,” said Victoria Hahn.
Burnout is a well-documented issue in healthcare, and it has run rampant throughout the field over the course of the pandemic especially. No provider wants to be in a situation that demands futile care be given.
What causes medical overuse?
Seeing as medical overuse wastes money, hurts patients and hurts providers, why is it such a prevalent issue in healthcare? To get to the bottom of this, Lyu et al. conducted a survey in 2017 designed to understand the physician perspective on the underlying causes and realities of medical overuse.
2106 providers responded to the survey, and they found that 11% of unnecessary care came from procedures, 25% from tests and 22% from prescription medications. Of all medical care delivered, according to respondents, 21% was deemed unnecessary. Now, why is this happening?
“The top three rationales were fear of malpractice at 85%, patient pressure or requests at 59%, and 38.2% was difficulty accessing prior medical records which often led to redundant tests or procedures,” said Hahn. While these rationales loomed large in this survey, another reason was identified in a 2022 study.
“In a cross-sectional, mixed methods study of 40 physicians, they found that volume was the most commonly included compensation method for primary care and specialists. That’s 68.2% for primary care and 73.7% for specialists on average. However, compensation for quality care and patient safety represented around 5% to 3%,” explained Hahn.
These findings laid bare an unfortunate relationship between patient volume and compensation. If the best way to make more money as a provider is simply seeing more patients, as opposed to providing the highest quality care, medical overuse is bound to occur along the way.
How can medical overuse be addressed?
No single solution will completely curtail medical overuse, but there are some ideas currently to address it. Some of these include better training of residents on appropriateness criteria, easier access to health records, price transparency with tests, more peer review, and more regulation. In this section though, we will focus on decreasing fee-for-service incentives that can lead to unnecessary care. Shifting to a value-based care model instead could reduce extraneous procedures and improve the quality of care overall.
“What if we are incentivized based on providing care that improves the patient’s health outcomes relative to the cost of care. Value-based care is all about improving health outcomes, but how do we evaluate value-based care? Well, we first need to understand what matters most to the patient, and patient reported outcomes (PRO’s) are a powerful way to measure and understand that,” says Hahn.
PRO’s, according to the FDA, are, “any report of the status of a patient’s health condition that comes directly from the patient without interpretation of the patient’s response by a clinician or anyone else.” For a more thorough breakdown of the types of PRO’s and PROM’s, you can find Victoria’s full explanation from the presentation timestamped here.
One of the most effective ways to implement PRO’s into your practice is through an ePro tool like OutcomeMD. The right ePRO system can reduce the burden of paper forms, improve patient engagement, streamline data collection and analysis, and make the scores you receive easier to interpret for both you and your patients. OutcomeMD integrates directly into DrChrono’s EHR system, so it can be utilized naturally in the flow of your clinical documentation.
Though implementing a value-based care approach may not be a medical overuse cure-all, it can still improve your patient experience while reducing excessive spending on superfluous procedures.
Medical overuse is a serious issue in healthcare, and its negative effects are felt by patients and providers alike. Perhaps more systemic changes may be needed to reduce these occurrences, but in the meantime, there are steps in the right direction that your practice can take today. Prioritizing value-based care through the implementation of PRO’s can have a dramatic impact on the care you give at your practice.