Large Medicare study explores common predictors of low-value imaging among hospital systems
Health systems with a lower share of primary care physicians or no affiliated teaching hospital are more likely to deliver low-value imaging and other services, experts detailed Monday.
Those serving a larger proportion of non-white patients, headquartered in the South or West, and stationed in geographies with higher healthcare spending also face greater odds of delivering unnecessary treatment. The findings are part of a large-scale analysis of 41 low-value healthcare services—including 18 in imaging—published in JAMA Internal Medicine.
“More and more Americans are getting care from health systems as opposed to standalone practices. Given actionable data, these systems have enormous potential to influence decision-making on low-value care,” lead author Ishani Ganguli, MD, a researcher in Brigham and Women’s Division of General Internal Medicine and Primary Care, said Sept. 27. “We hope this work might motivate systems to measure and intervene on low-value care internally.”
To reach their conclusions, researchers analyzed data covering more than 11.6 million Medicare beneficiaries treated at 556 U.S. hospital systems. Low-value services studied included imaging to assess uncomplicated headaches, emergency CT scans for dizziness, and MRI of the peripheral joints to monitor rheumatoid arthritis. Preoperative lab testing was the most prevalent unnecessary service, delivered to 28% of patients in the study, followed by prostate-specific antigen testing in men older than 70 (27%), and prescribing antipsychotics to patients with dementia (24%).
Meanwhile imaging for eye disease (8.8%), short-interval repeat dual-energy X-ray absorptiometry (8.2%), headache scans (4.9%), and carotid artery evaluation for simple syncope (3.2%) led the way in the “imaging” category. Ganguli et al. additionally found significant positive correlations between different categories of low-value services, with the highest between lab testing and procedures. That included notable correlation between 28 of 66 pairs of imaging test measures (19 positive and 9 negative).
“Correlations between cardiac screening measures and between head imaging measures raise the possibility that system factors, such as screening protocols or capital investment in imaging technology, may contribute to system-specific practice patterns,” the authors noted. “At the same time, some heterogeneity in low-value care provision within health systems was not surprising given the diverse drivers of these services,” they added.
Ganguli and colleagues also used the 28 most common low-value services to create composite scores for comparing performance across health systems. You can find the full rankings and additional charts and data in JAMA here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.