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A Critical View of Low-Value Medical Care

A Critical View of Low-Value Medical Care

Traditionally, the value of medical care has been determined by the effectiveness and safety of a given intervention, regardless of that intervention’s cost. The current goal is to provide the highest-value solutions that are effective, safe, and have the lowest possible cost, according to Craig A. Umscheid, MD, MSCE. “Low-value diagnostic and therapeutic interventions waste patient and prescriber time and money and can even be harmful,” he says. “Low-value care takes away time that providers could be delivering high-value care.” Contributing Factors Defensive medicine practices can be a significant contributor to low-value medical care (Table 1). For example, providers may order diagnostic tests because they are fearful of malpractice suits if there is even the slightest chance that patients could have a disease or condition, says Dr. Umscheid. He discussed his experiences with low-value medical care as a patient in JAMA Internal Medicine. “The healthcare system often supports low-value versus high-value care,” he says. “Physicians who see many patients per day in order to make enough revenue to support their staff, clinic, and livelihood may opt for approaches that are quicker and easier when caring for patients. This strategy may be of low value when compared with approaches that could be taken if physicians had the time and ability to be more invested in their patients’ well-being.” Often, physicians do not know or have access to information about the costs of the diagnostics and therapeutics they prescribe. Others may be unaware of the percentage of costs that patients will assume if they undergo these procedures. “Value can’t be assessed if the costs are unknown,” Dr. Umscheid says. “Further complicating...
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