Study finds that physicians believe a fifth of all medical care is unnecessary with fear of lawsuits identified as a primary driver for wasteful healthcare practices, but fee-for-services also seen as a major contributor.
The study also identified a number of solutions for mitigating the problem including increased training, better access to health records, and improved guidelines.
Excerpt: “Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.
“Methods. 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment.
“Findings. The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.
“Conclusion. From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.”
Source: PLOS Journal
WBB Take: Overproduction is one of the seven “deadly wastes”, and in healthcare can manifest itself as providing “low value” care, providing excessive care, or working at a higher level of care than is medically necessary.
Some overproduction is the result of physicians being prudent, and erring slightly on the side of over-treating rather than undertreating. Slightly too much tissue removed in cancer surgery is typically viewed of as less harmful than removing too little. Placing a patient at a slightly higher level of care may add unnecessary cost, while placing the patient at a lower level of care than needed can be dangerous.
While this form of over-treatment is therefore unavoidable to some degree, a waste level of 20-30% is far higher than mere prudence, and is itself a form of harm. Too much radiation, too much pain medication, or too many surgical encounters can do far more than just waste money, they can be sources of severe injury.
A further consideration is the interaction between overproduction and safety events. The U.S. suffers from a high rate of medical error, and increasing utilization also increases risk of medical error. With every medical intervention comes risk, and a 20-30% level of overproduction greatly increases opportunities for a medical error that may cause harm. Indeed, some “never events” occur in that 20-30% overproduction.
To reduce patient harm, the industry must address the causes of overproduction, and greatly shrink the degree of waste that is currently in the system.
Cited by Wes Hammond, Shannen Irwin, and Matthew Loxton