Mismanaged patient care contributes to an estimated $600 billion in unnecessary health care spending every year in the U.S.
A new Johns Hopkins study found that 14.7 percent of Medicare patients underwent at least one unnecessary procedure in 2008 due to poor coordination among care providers.
"There are a number of policies and processes that might help eliminate unnecessary care including strengthening primary care medical homes and building accountable care organizations," Dr. Craig Pollack, senior author of the study and internist and associate professor of medicine at Johns Hopkins, told DOTmed News. "Our research highlights one critical pathway through which these reforms may achieve this goal — improving care continuity."
The researchers evaluated Medicare fee-for-service claims for over 1.2 million patients over age 65, which accounts for 5 percent of all Medicare claims from 2008. They then used a previously validated set of 19 overused procedures and measured continuity of care.
Overused was defined as services that may have been provided without clear medical basis and when the risk of harm surpasses its likely benefit. A few examples of overused procedures are antibiotics given for simple respiratory infections and preoperative chest X-rays.
They found that high continuity of care was associated with a lower chance of undergoing nine of the overused procedures — six out of 13 of the diagnostic tests and all three of the therapeutic procedures.
The average Medicare patient has 13 medical visits per year, divided between an average of two primary care physicians and five specialists. Previous studies have shown that poor continuity in care is associated with higher costs and lower quality of health care but the connection between continuity and procedure overuse has not been investigated until now.
The researchers said that overuse is due to physicians not following clinical guidelines and unintentionally ordering procedures that a patient already received. The lead author of the study, Dr. Max Romano, said patients don't know which procedures are necessary and put a lot of trust in the health care system and providers to make the decisions.
But Romano cautioned that this study has limitations since it only investigated the connection between continuity and overuse. He hopes that his research will encourage a deeper investigation that can validate their findings and establish a casual relationship between continuity and overuse.
Once more in-depth research is conducted, Romano believes that it could lead to a “variety of policy decisions that could change our health care system for the better.”
