Study Finds Low-Value Services Increases Risk for Direct Harm

A study analyzing Choosing Wisely recommendations found that nearly 50 percent of identified low-value services may cause direct potential harm.

Published in JAMA Network, researchers studied the expected impact of low-value service identified in Choosing Wisely recommendations by US physician societies between March 2021 and May 2021.

The researchers looked at 626 recommendations and identified the low-value services by society type, service type, indication, do versus avoid, and clinical context. In addition, they categorized the range of expected impact by the effect on the revenue of society members, cost, number of individuals at risk, direct harm potential, and cascade potential. 

Nearly 27 percent of the low-value services identified by Choosing Wisely covered imaging and 25 percent covered laboratory studies. 

Low-cost services represented an increasing number of low-value services identified by the Choosing Wisely recommendations.

Researchers noticed that 64 percent of the low-value services  were revenue neutral for the recommending society, and the plurality was low cost with 45 percent less than $200.

Additionally, 44.7 percent of identified low-value services were found to have high direct harm potential. 

Meanwhile, 62 percent of identified low-value services had high potential for cascades, or triggering downstream services.

The results indicate that Choosing Wisely’s recommendations identified services with a wide range of expected impacts. 

“Stakeholders could explicitly set priorities for future recommendations, while clinical leaders and payers might target intervention efforts on recommendations with the greatest potential for impact based on spending across populations, direct harms, and cascades,” the researchers suggested in the study. 

The US Choosing Wisely campaign has had considerable reach in rallying efforts to decrease low-value care, largely by employing physician specialty societies in stewardship.

According to a study from the healthcare think tank, low-value care has no clinical benefit and puts thousands of patients at risk of harm.

The study showed that hospitals in the US deliver a low-value test or procedure every 80 seconds to an adult over 65.

A study from 2019 showed that low-value care is estimated to contribute between $75 billion and $101.2 billion in wasteful healthcare spending.