Brian Powers of Humana on low-value care and de-adopting in the ASC

Humana's Deputy CMO Brian Powers, MD, shared his thoughts about low-value care in ASCs with Becker's ASC Review.

Note: Responses have been edited for style and clarity.

Question: Which medical settings do you see low-value care most prevalent?
Dr. Brian Powers: Low-value care occurs across all healthcare settings. A big part of the challenge in reducing low-value care is that it can be hard to identify low-value care, especially with administrative data alone. Researchers have done this in certain cases, especially in the Medicare population. The authors of a 2014 study published in JAMA Internal Medicine found that imaging and cardiovascular testing and procedures were responsible for most low-value spending, with cancer screening, perioperative testing and other surgery accounting for a smaller share.

Q: How should physicians think about low-value care? What steps should physicians take to de-adopt?
BP: As a physician, I think about low-value care the same way I think about any test, procedure or other service — what are the risks and benefits for my patients? By definition, low-value care provides little or no value to patients. As we note in the paper, there will always be reasonable uncertainty and disagreement on what procedures are "low-value," but for many there is rather incontrovertible evidence. As physicians, we need to stay up to date on this evidence, and communicate the benefits (or lack thereof) to our patients, helping them to make an informed decision. More often than not, I think this level of transparency and communication around value will result in fewer patients electing low-value care.

Q: How do ASCs fit into the ecosystem of high-value and low-value care?
BP: Not much is known on this topic. As more procedures shift to ASCs (including some that are potentially of low-value), it will be important to study whether ASCs in general (and the ownership, financing and affiliation structures therein) impact rates of low-value care.

Question: How do you anticipate de-adopting low-value care would affect the quality of a medical center?
BP: By definition, low-value services provide little or no benefit to patients. And some even come with risks. De-adopting low-value care should not adversely affect the quality of any delivery organization. In fact, reducing low-value may increasingly be looked at as a quality measure itself.


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