The American College of Physicians
is pushing for greater use of performance measures targeting overuse and misuse of healthcare services.
In a 19-page position paper released Monday, the group argues that measures that gauge the use of "low-value services," such as imaging for low back pain or nonindicated cancer screenings, can raise awareness about healthcare misuse and change clinician behavior.
"Just as we need performance measures to assess underuse of high-value services, we need valid, evidence-based measures of overuse," according to the paper.
The authors outlined a number of approaches for measuring clinicians' utilization of "low-value services," including the use of metrics that evaluate the appropriateness of a particular treatment given the circumstances of individual patients.
"For example, a direct measure of imaging for patients with acute low back pain would determine whether an imaging test was performed that is typically of low value and whether there were unusual circumstances present that justified the imaging test," the authors said.
Direct measures, while more accurate, require standardized and detailed clinical information that is often unavailable, they added.
More practical are indirect measures, such as ones that track providers' utilization rates for specific services or calculate rates of negative test results for a screened condition. High rates of negative tests can indicate that a particular diagnostic test was used too frequently in low-risk patients, according to the paper.
The authors that predicted such measures will be used to provide physicians with feedback about their performance and could also be used as part of public-reporting and pay-for-performance programs. But there are potential pitfalls, they warned.
"Pay-for-performance programs that use indirect measures to address use of low-value services run the risk of decreasing use indiscriminately so that some patients who need services do not receive them," the ACP wrote.