Spending growth on five well-known low-value healthcare services declined slightly from 2014 to 2016, according to a new report.
The analysis, published this week by consultancy Altarum and funded by the PhRMA Foundation, found spending growth on five low-value services decreased on average by 1.7% annually over the two-year period. By comparison, total commercial insurance spending increased by 6.6% on average over the same time frame.
Although spending growth on low-value services did decrease, it was less than expected given the widespread awareness and concern for the problem, said Beth Beaudin-Seiler, an author of the report and senior analyst at Altarum.
"What we are seeing here is a lot more talking and analyzing about the problem but now we need to move into the 'what we need to do stage,'" she said.
The slow progress on declining use of low-value services has been documented in other studies. For instance, a 2017 study in Health Affairs found low-value care persisted five years after the Choosing Wisely campaign launched.
Many reasons are to blame for the problem including cultural and behavioral norms of physicians and patients. The current fee-for-service reimbursement model also only encourages waste by creating incentives for doctors and hospitals to order more services.
The PhRMA Foundation funded the analysis as part of its Value Assessment Initiative, which has supported since 2017 more than $1.4 million research projects focused on new approaches to defining and measuring value to improve treatment and lower costs.
The analysis used claims data from a large undisclosed commercial insurer that covers more than 10 million lives. Beaudin-Seiler noted that because the analysis only looked at data from one payer the results aren't comprehensive of the industry but rather offers a "snap shot" of the issue.
The five low-value services used were Vitamin D screening tests; prostate-specific antigen tests in men over 75; unnecessary testing and laboratory work prior to low-risk surgery; imaging for uncomplicated low-back pain within the first six weeks and use of more expensive branded medications when generics were available.
Beaudin-Seiler said the low-value services selected are commonly referred to as such in the literature.
Even though overall spending growth on the low-value services decreased, some services saw increases. For instance, spending growth on imaging for lower back pain rose by 44% from 2014 to 2016. The analysis estimates that about $355 million was spent on the service alone in 2015 for the privately insured population.
Beaudin-Seiler said the reason for the increase is hard to determine but it may be because back pain is a prevalent issue for younger, working adults.
In addition to looking at spending on low-value services, the analysis examined how spending on high-value services has changed. High-value services were defined as services well-recognized in the industry that result in positive outcomes for patients.
The five high-value services the analysis examined were retinopathy screening for diabetics; influenza vaccinations; HIV therapy drug regimens; vaginal deliveries and healthy behaviors counseling for weight loss, tobacco use or substance use disorders.
The analysis found spending on these high-value services grew by 5.6% on average from 2014 to 2016.
Beaudin-Seiler said that although that's a good sign, there is still room for improvement. While spending on healthy behaviors counseling and HIV therapy rose significantly, spending on vaginal deliveries and retinopathy screening only increased slightly.
"There is more work to be done," she said.