Low Value Care in Pediatric, Inpatient Care Cost $17M in 2019

Low-value care in pediatric inpatient care has a high price tag, according to a recent study published in JAMA Network Open on pediatric hospital spending for low-value services.

“As strategies to measure pediatric low-value care evolve, hospital-based care warrants particular attention. This care is increasingly costly, and literature on overuse of nonrecommended hospital-based pediatric services is robust, suggesting improvement opportunities,” the researchers wrote.

The researchers assessed low-value care services in over one million pediatric encounters over the course of 2019 using data from the Pediatric Health Information System (PHIS) database. The encounters occurred in 49 hospitals and included two groups, one consisting of encounters that ended in an emergency room discharge and the other of encounters that ended in a hospital discharge.

In order to estimate the costliness of low-value services, the researchers developed a calculator using evidence-based quality measures and with the help of a multidisciplinary stakeholder group. The tool calculated the percent and number of patient encounters that involved low-value services and the healthcare spending that resulted from these low-value care services.

More than half of the low-value services occurred in the emergency department (55 percent). Pediatric bronchiolitis cases were the most expensive, costing the healthcare system over $3.6 million in low-value care services. Pediatric behavioral healthcare low-value treatment followed not far behind, costing almost $2.4 million.

According to the researchers’ calculations, the most common low-value service in the emergency room group Group A streptococcal testing for children under three years with pharyngitis. Nearly four in ten children in this group experienced low-value care (37.6 percent). 

Additionally, in the emergency room group, nearly 18 percent of children who had a minor head injury received low-value care services through computed tomography (17.7 percent). Sixteen percent of the children in this group were put on bronchodilators for bronchiolitis.

Meanwhile, hospitalized children most frequently experienced low-value care when being treated for community-acquired pneumonia, with six in ten children who had this diagnosis receiving broad-spectrum antibiotics.

Moreover, half of all infants who had esophageal reflux were treated with acid suppression therapy, a low-value service. And nearly four in ten children with uncomplicated  community-acquired pneumonia were treated with blood cultures, another low-value service.

The highest-cost low-value services included emergency department computed tomography scans for abdominal pains, emergency department computed tomography for minor head injuries, emergency department chest radiography for asthma cases, concurrent antipsychotic medications in the hospital setting, and chest radiography for hospitalized bronchiolitis and asthma cases.

The researchers urged readers to eliminate nonevidence-based procedures and services.

“These results highlight the importance of assessing the trajectory of low-value care over time; our calculator can facilitate the longitudinal measurement needed to establish such trends. Our investigation also identified low-value care for conditions that have historically not been prioritized for deimplementation,” the study noted. 

“Continued application of this tool will aid in establishing and monitoring temporal low-value care trends and identifying services in need of ongoing deimplementation efforts.”

Payers are constantly looking for ways to reduce and ultimately eliminate low-value care. This study spotlighted areas of low-value care in pediatric, inpatient care settings and evaluates the costs associated with failing to address and divert these services.

Separate studies have indicated that primary care settings play a particularly crucial role in preventing low-value care services. However, this study from JAMA Network Open demonstrates the high cost associated with failing to address low-value care services in inpatient care as well. 

Armed with more specific spending data, payers can use quality measures and incentives in value-based contracts to help reduce low-value care in hospitals.