Virginians spent $747 million on more than 2 million unnecessary medical services in 2017, according to the Virginia Center for Health Innovation.
To tackle the multilayered issue of unnecessary tests and procedures throughout the state, VCU Health and five other Virginia medical institutions are forming a large-scale health system learning community with the aim of reducing seven pre-identified low-value care measures. VCHI secured a $2.2 million grant from philanthropy organization Arnold Ventures to lead this statewide pilot over the next three years.
VCU News spoke with Tom Yackel, M.D., president of MCV Physicians, to discuss what constitutes low-value health care and what VCU Health is doing to help eliminate it.
What is low-value health care, and what does it look like for patients?
Low-value health care is any test, medication or treatment that provides little to no health benefit for a patient. In some cases, low-value care may even be harmful. More than 80 medical societies across the country have published common-sense guidelines for physicians and patients that identify the types of care that we should call into question.
These low-value services include things such as unnecessary medical screening for patients undergoing cataract surgery; ordering an MRI or CT scan in patients with hoarseness without looking at their vocal cords first; using antibiotics to treat the common cold; ordering unnecessary [electrocardiograms]; transfusing a patient with more blood than they need; and screening low-risk patients for vitamin D deficiency.
Assessing and addressing questionable health care is important. Exposing patients to unnecessary testing or treatment increases their risk for side effects. And, speaking from a financial standpoint, the low-value services expose patients to higher costs for care.
What will this grant look like?
The grant will allow researchers to develop a scorecard for physicians and health systems to use and understand where low-value care may be occurring in their practices. VCHI’s learning collaborative of health systems will use the scorecards to identify ways to reduce the amount of low-value services we’re offering in our community.
What is VCU Health’s involvement in this research?
VCU Health is a member of VCHI’s Leadership Council. VCU Health was an early supporter of the grant application and we contributed ideas and data to assist in its ultimate funding. Now that this project is underway, VCU Health will be a key health system partner for VCHI. We will coordinate the distribution of scorecards; review practice-level data; work with clinicians to identify ways to modify, adapt and improve clinical practice; and share our learnings with the community.
What are you hopeful the outcome will be for patients?
For me, this work mirrors part of the Hippocratic Oath I took on the day I graduated medical school: To apply, for the benefit of the sick, all measures required, avoiding the twin traps of overtreatment and [undertreatment].
We are using the scientific method to create evidence-based treatments for our patients. We want to help them get — and stay — healthy while protecting them from receiving medical treatments they do not need.
If successful, this study could serve as a model for improved health care practice and spending nationally.