Top 5 Low-Value Services Driving Healthcare Spending

Despite a push to move towards a value-based care system, the current design of healthcare is fee-for-service, meaning that a provider offers a service that a patient or payer must reimburse them for. Critics of this system charge that it results in patients receiving unnecessary tests or examinations in order to generate greater profit for providers; however, proponents of the system disagree with this contention.

Many healthcare stakeholders have used fee-for-service and unnecessary spending as a reason to accelerate the transition to value-based care, which bases reimbursement on the value a service provides to a patient. For example, under this arrangement, the amount a provider receives may be based on whether a patient with diabetes achieves target A1C levels.

According to a press release from VBID Health, billions are spent on unnecessary services each year.

The top 5 overused, low-value services include:

• Diagnostics and imaging for low-risk patients before receiving low-risk surgery
• Vitamin D screening
• Prostate-specific antigen screening in patients 75 years and older
• Imaging for low-back pain within the first 6 weeks
• Use of branded drugs when a generic is available

These 5 services are responsible for at least $25 billion in unnecessary spending each year and all have scientific consensus against their use, according to the release.

“While the Choosing Wisely initiative has played a critical role in promoting discussions between patients and their clinicians around low-value care, purchasers have a responsibility to be good stewards of health care resources and to protect their members from services that are unsafe, unhelpful, or both,” said A. Mark Fendrick, MD, co-director of the Task Force on Low-Value Care.

In order to accelerate the transition to value-based reimbursement and reduce unnecessary healthcare spending, VBID Health created the Task Force on Low-Value Care, according to the release.

“By targeting a focused set of services, we believe we can achieve some early wins, improve patient care, and save much needed resources that can be redirected into higher value health care services,” said Beth Bortz, president and CEO of the Virginia Center for Health Innovation. “In 2015, Virginia spent more than $247 million on diagnostic testing and imaging for low-risk patients before low-risk surgery. We consider reducing the use of this service, and the other 4 identified, just the tip of the spear.”