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Washington residents' tab for unneeded care in a year: $280 million-plus

Roughly 622,000 Washington state residents received low-value services over one year, which collectively cost about $282 million, a new report found.

The not-for-profit Washington Health Alliance's study found that 45.7% of the 1.5 million total services it analyzed from July 2015 to June 2016 were unnecessary and wasteful according to recommendations from the Choosing Wisely campaign.

All in all, the alliance examined insurance claims from 1.3 million Washington residents who received one of 47 common treatments from July 2015 to June 2016. These 47 treatments have been flagged by the Choosing Wisely campaign as frequently overused.

The alliance found that 11 of the 47 services accounted for 93% of the total low-value services. The 11 services include antibiotic prescribing for ear infections and annual cardiac screening in low risk individuals.

"The list of 11 is a starting point for us," said Susie Dade, author of the report and deputy director at the Washington Health Alliance. "I think they will become a rallying point for coming up with specific education and specific interventions."

The Washington Health Alliance along with the Washington State Medical Association and the Washington State Hospital Association work together on ways to decrease the frequency of low-value services with a grant from the Choosing Wisely campaign.

The report also highlighted several ways to reduce the use of low-value services in the state and nationally. Washington state medical societies are called on to "take up the mantle and lead provider efforts to incorporate reduction of overuse into local practice culture."

Dade said physicians can have an impact on the problem by changing how they speak with their patients about treatment plans. She recommends that when doctors lay out the risks and benefits of different services, costs are brought up as well. "We don't think of harm (to patients) in terms of financial harm ... given the advent of high-deductible health plans where people have much more out-of-pocket exposure, I think we need to have those conversations," she said.

Dr. John Mafi, an assistant professor of medicine at the University of California at Los Angeles, expects that solutions to the systematic overuse of healthcare services will come from the "bottom up." He said healthcare systems and medical schools have huge roles to play to change the culture of how physicians treat and communicate with their patients about treatment options.

"I think there is no magic bullet to fix this, there is no secret formula — if and when it does get fixed, it will be organic, from the bottom up," he added.

Dade did note that the design of value-based payment models at the federal level can have an impact. In addition to the measures already considered in the programs like total-cost of care, Dade said it would be beneficial to factor in measures that signal overuse like ordering images for an uncomplicated diagnosis.

"Total cost of care targets are essential, but in of itself it may be insufficient to really hone in on specific areas of overuse," she said.


Maria Castellucci

Maria Castellucci covers safety and quality topics for Modern Healthcare’s website and print edition. Castellucci is a graduate of Columbia College Chicago and started working at Modern Healthcare in September 2015.

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