In the two-year period of Jan 1, 2015 through December 31, 2017, the Lown Institute found 1.3 million low-value tests and procedures delivered by 3,351 hospitals. The report found that for-profit and southern hospitals had the highest rates of low-value tests and procedures noting that hysterectomies for benign disease were one of the highest tracked with more than 64% meeting criteria for unnecessary.
The American Hospital Association asserts the report is not operating with all the facts and context. The organization contends via a blog post that the study from the Lown Institute “attempts to make sweeping conclusions about hospital value based on data that are not only incomplete, but also not current.”
Who is right? There is overuse and unnecessary care that occurs. National efforts like Choosing Wisely or the Task Force on Low Value Care attempt to address that. Similarly, relying on Medicare billing data for a handful of procedures without any real-world input from patients or providers cannot be the final answer on what is deemed necessary or appropriate.
While the back and forth about low-value and unnecessary care continues, the use and measurement of shared decision making provides an additional opportunity for the provider and patient to discuss value and the necessity of a test or procedure prior to undertaking and generating the claim. It may be the middle ground needed while more efforts to effectively measure low-value care develop.