Low-care Value Not Associated With Healthcare Experience Ratings, Study Finds

Some research suggests that physicians may provide unnecessary or marginally useful services because patients want the services and physicians cater to their wishes. But results reported this week in JAMA Internal Medicinepoke a hole in that theory. A research team led by Prachi Sanghavi, Ph.D., of The University of Chicago did not find an association between “low-value” care and higher ratings on a standard survey used to assess patient experience.

Sanghavi and her colleagues said their findings may reduce the use of low-value care to appease patient and alleviate concerns that the patient experience and satisfaction scores used in value-based care could be counterproductive.

Sanghavi conducted their study by sifting through Medicare fee for service for eight low-value service, such PSA tests for older men, cervical cancer screening for older women, head imaging for uncomplicated headache. They used that data to create composite measure of exposure to low-value care.

For patient experience, they used results from the Consumer Assessment of Healthcare Providers and System (CAHPS) Medicare fee-for-service survey. That survey asks questions about interactions with physicians, such as whether the physician listened carefully to the patient and explained things clearly, as well as about timely access to care and overall rating of the healthcare services the patient has received.

They assessed the association between “exposure” to low-value care and CAHPS results for 100,743 primary care professional (PCP) patient panels that had, on average, 258 patients per panel. For the most part, their analysis did not find a statistical link between exposure to low-value care and a better health experience as measured by CAHPS. But the study also did not find an association between low-value care and a worse health experience as measured by CAPHS, with one exception: long waiting room times were associated with exposure to low-value care. One possible explanation offered by Sanghavi and her colleagues is that “poorly organized or overwhelmed practices substitute wasteful services for higher-value services that require more cognitive effort and clinician time.”

“We did not find evidence that patients who are exposed to more low-value care rate their health care experiences better,” they concluded. “They also generally do not rate their healthcare worse, which may because they are unable to assess the value of care or because their physicians effectively correct information asymmetries through shared-decision making when denying low-value services.”