Primary Care Physicians Influence LVC Spending, Studies Show

June 19, 2019 - Studies have found that primary care physicians (PCPs) play a role in increasing low-value care (LVC) expenditures, indicating that payers, policymakers, and healthcare organizations should incentivize and enable wise spending on the primary care level, a slate of new researchers have concluded.

Despite the widespread emphasis on cutting low-value care expenditures, a study from the Research Consortium for Health Care Value Assessment evaluated the five low-value and five high-value private healthcare services and found the results “underwhelming.”

Although low-value annual care spending saw a 1.7 percent decrease during this time period and high-value annual care spending saw around 5.6 percent growth, on the whole, LVC increased by two percent between 2014 and 2016, according to the Research Consortium.

“While the selected low-value care services are not growing faster than national health care expenditures, it is not the decrease expected, given the attention to eliminating low-value care and the specific services measured,” the researchers stated.

A separate study by the Massachusetts Health Policy Commission in 2018 observed low-value care expenditures in the state. The study concluded that Massachusetts patients paid over $12 million in out-of-pocket costs for LVC procedures over the two year period. This statistic does not include spending "downstream" costs such as follow-up tests, the Massachusetts HPC added.

However, the HPC research also indicated that the numbers were largely dependent on the primary care physicians (PCPs), with variation as great as two times the amount of LVC expenditure per provider organization.

Another recent study published in the Journal of the American Board of Family Medicine looked at PCP characteristics related to less LVC spending.

The researchers on PCP characteristics found that the location of the practice has a significant impact on the amount of LVC spending in a practice or clinic.

PCPs who spent less on LVC tended to be female, a family medicine practitioner, and had a smaller Medicare patient panel. Most had an allopathic background, practiced in the Midwest or rural areas, or were a recent graduate.

“Our analysis suggests that LVC services are associated with specific PCP characteristics. Further research should assess the strength of these associations, and future policy efforts should focus on systemic interventions to reduce LVC spending,” the researchers concluded.

As these traits become more defined, more PCP-targeted solutions are arising. A separate project received grant funding from the Arnold Venture to cut LVC at the primary care level.

The funding, awarded to the Virginia Center for Health Innovation (VCHI), will create a network of Virginia health systems and clinically integrated networks committed to this goal.

“Each health system and clinically integrated network will review baseline and practice-level performance data from the Milliman MedInsight Health Waste Calculator, develop system improvements based on that data, and share best practices with other providers in the learning community,” Beth Bortz, President and CEO of the Virginia Center for Health Innovation explained in the press release.

Virginians spent $747 million on 2.07 million LVC procedures in 2017. The VCHI reported that 39 percent of its members engaged in at least one LVC procedure, resulting in $11.48 per member per month (PMPM) expended on these measures.

The three-year long program aims to reduce seven LVC measures by 25 percent. To accomplish this goal, the VCHI will “increase clinician competence in reviewing performance reports and implementing targeted interventions to improve outcomes [and] improve understanding of which interventions are effective in reducing seven provider-driven low-value care tests and procedures and provide health systems and practice leaders throughout the country with tested best practices they can implement.”

The organization also targets patient and employer involvement, seeking to “reduce the physical, emotional, and financial harm patients experience from unnecessary tests and procedures and educate Virginia employers (including state government) on the actions they can take to drive complementary payment reform that better incentivizes value in health care.”

By concentrating on PCP education and empowerment in appropriate healthcare spending, payers, policymakers, and healthcare organizations may achieve greater success in lowering LVC expenditures.