Low-value care, or tests and services that offer little to no medical benefit, can be a strong indicator of wasteful health care spending. In a paper published in JAMA Internal Medicine, Bruce Landon and coauthors at HMS, HPSH, BIDMC and UCLA found that hospital-based primary care practices prescribed more services indicative of low-value care than those practices based at community-based primary care clinics.

Hospital-based specialists showed an overreliance on referrals to specialists, CT scans, MRIs and X-rays—services that research has shown account for up to one-third of wasteful medical care.

In an associated press release, Landon said: 

Hospital-based practices need to be aware of their tendency to overuse certain tests and services of questionable therapeutic value for patients with uncomplicated conditions. That knowledge can help both frontline clinicians and hospital leaderships find ways to eliminate or at least reduce such unnecessary services.

The researchers noted that these results may help develop strategies to reduce wasteful care. They also postulated that continuity of care—seeing the same physician over a period of time, is also important. Landon said,

Not seeing your regular primary care physician—what we call discontinuity of care—might be a weak spot where low value care can creep in. The more we know about what situations are most likely to lead to patients’ receiving low-value care, the more we can do to prevent it.

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