Infectious Disease

Providing substandard care does not improve physician ratings

Source / information

Disclosure:
McWilliams reports that he serves as an unpaid board member for the Institute for Accountable Care and receives personal fees from the Medicare Payment Advisory Commission for advising on the application of low value care measures outside of the work submitted. Sanghavi does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

Researchers found no association between low-value services and patients’ ratings of their health experiences, an analysis of Medicare claims found.

According to researchers, patient experiences and assessments are often used to “incentivize quality improvement through public reporting and performance-based payments”.

The widespread use of patient-reported health experiences can “encourage physicians to provide services of lesser value (care that is not associated with clinical benefit) based on the belief that patient demand is being responded to or the perception that that more care is better will improve their ratings ” Prachi Sanghavi, PhD, an assistant professor of life sciences in the Department of Public Health Sciences at the University of Chicago, and colleagues wrote in JAMA Internal Medicine.

Prachi Sanghavi

“This can lead to wasteful use of health care resources and spending, possible iatrogenic injuries, and limited success of alternative payment models such as accountable care organizations,” they said.

Previous studies assessing this relationship did not “adequately” consider certain factors, such as: B. how sick a patient might be, which could be a confusing factor, “Sanghavi said in a press release.

“For example, people who are chronically or terminally ill may need more care and develop closer relationships with their doctors, which in turn could lead to higher patient satisfaction ratings,” she added.

From January 1, 2007 through December 31, 2014, Sanghavi and colleagues analyzed Medicare fee claims for approximately 26 million beneficiary years and 100,743 primary care professionals to determine who would have ordered unnecessarily inferior services for them. These low-value services included PSA testing in older men, carotid disease screening in asymptomatic adults, cervical cancer screening in older women, parathyroid hormone test in patients with stage one to three chronic kidney disease, and free T3 testing in patients with hypothyroidism , Back imaging for nonspecific lower back pain, spinal injection for lower back pain, and head image for uncomplicated headache.

The researchers also examined health care reports from independently surveyed benefit recipients who answered the Medicare Fee Collection for Healthcare Providers and Systems (CAHPS) questions from 2010 to 2015 regarding universal health care, waiting time for appointments, timely access to non-urgent and urgent people answered care, overall assessment of personal doctor, clarity of communication, careful listening, respect and reasonable time.

According to Sanghavi and colleagues, the only “notable association” they found was an association between lower exposure to care and more frequent reports from patients waiting longer than 15 minutes after a scheduled appointment. On average, patient groups most affected by low-quality care rated this variable 0.448 points lower than patient groups least-affected by low-quality care on a 10-point scale that rated CAHPS.

“Although some other associations were statistically significant, their sizes were much smaller than those normally considered significant in other CAHPS references and were inconsistent with levels of exposure to low-value services,” the researchers wrote.

The results suggest that the physician’s concerns that a treatment with lesser value leads to better patient ratings are “exaggerated,” according to the study co-author Michael McWilliams, MD, PhD, Professor of health policy at Harvard Medical School and general internist at Brigham and Women’s Hospital, said in the press release.

“We should be reassured that we can tackle waste in the system without major setbacks from patients or failing providers on their scorecards,” he added.

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

Related Articles