Low-Value Service Use in Provider Organizations.

Area of Science:

• Health Services Research
• Health Economics
• Clinical Practice Patterns

Background:

• Low-value healthcare services, defined as those providing minimal clinical benefit, contribute to increased healthcare costs and potential patient harm.
• Understanding variation in low-value service provision among provider organizations is crucial for developing targeted quality improvement initiatives.
• Previous research has highlighted physician-level variation, but less is known about organizational-level patterns of low-value care.

Purpose of the Study:

• To investigate whether distinct provider organizations exhibit unique patterns in the utilization of low-value services.
• To quantify the variation, persistence, and inter-service correlations of low-value service use across provider organizations.
• To explore the potential role of organizational factors in shaping physician practice patterns regarding low-value care.

Main Methods:

• Analysis of Medicare fee-for-service claims and enrollment data from 2007-2011.
• Inclusion of 4,039,733 beneficiaries and 3,137 provider organizations.
• Multilevel modeling was employed to estimate variation, persistence, and correlations in the use of 31 low-value services, adjusting for beneficiary characteristics.

Main Results:

• Provider organizations averaged 45.6 low-value services per 100 beneficiaries, with significant variation across organizations (90th/10th percentile ratio: 1.78).
• Low-value service use demonstrated high persistence within organizations over time (r=0.98) and moderate positive correlations between different service categories (average r=0.26).
• The strongest correlations were observed between low-value imaging and cardiovascular testing/procedures (r=0.54).

Conclusions:

• Provider organizations display substantial variation in the provision of low-value services.
• The high persistence and consistency of low-value service use within organizations suggest that organizational factors significantly influence physician practice patterns.
• These findings underscore the importance of organizational-level interventions to reduce the utilization of low-value care.