The Shift Towards Measuring Low-Value Care: What Can We Learn from Decades Measuring Quality?
There is wide recognition that promoting healthcare value involves decreasing ‘low-value’ services—care without clinical benefit, little benefit compared with cost or disproportionate potential harm. A key element of achieving this goal is to create and track measures of low-value care.
In a new article published in BMJ Quality & Safety, VSSL member Drs. Leah Marcotte, Linnaea Schuttner, and Joshua Liao argue that while measuring low-value care is laudable and necessary, it is also challenging. Reasons include:
Existing data sources (e.g., claims), imperfectly capture clinical appropriateness of specific services
Need for valid measures that clearly define which facet(s) of value are being captured, and for which stakeholders
Risk of unintended consequences (e.g., clinicians focusing disproportionately on measured services to the detriment of other aspects of care)
Drs. Marcotte, Schuttner, and Liao argue that "while some growing pains are inevitable, policymakers and clinical leaders have the opportunity to maximise the benefits of low-value care measures by learning from efforts to measure healthcare quality." They highlight several key lessons:
1. Measure reliability -- ensuring that measures are computed using large enough sample sizes to capture true performance rather than random statistical noise/variation
2. Measure parsimony -- recognizing that measure proliferation leads to well-known information overload and administrative burdens for clinicians and health systems, and ensuring that stakeholders (e.g., policymakers, clinical leaders, insurers) work together to proactively guide the number of measures used for performance measurement
3. Alignment with financial incentives -- and in doing so, specifically ensuring that unintended consequences are mitigated