Annals of Internal Medicine tip sheet for Oct. 30, 2012

Policy Paper: American College of Physicians Offers Performance Measurement Recommendations to Help Physicians Practice High Value Care

2012-10-30

(Press-News.org) Health care expenditures are projected to reach almost 20 percent of the United States' GDP by 2020. Many economists consider this spending rate unsustainable. Up to 30 percent, or $765 billion, of health care costs were identified as potentially avoidable -- with many of these costs attributed to inappropriate or unnecessary services.

Evidence-based performance measures for low-value tests and treatments can be one of the ways to help physicians to provide high value care to their patients, according to the American College of Physicians (ACP) in a new policy paper published today in Annals of Internal Medicine.

Although the trend in the performance measurement arena has been to measure underuse of high-value tests and treatments, experts are increasingly developing performance measures to assess the use of low-value interventions. This new direction has the potential to improve health care quality by changing clinician behavior through feedback, public reporting, pay-for-performance programs, and clinical decision support.

Diagnostic imaging for uncomplicated low back pain is an example of a low-value intervention because the evidence indicates that the use of routine X-ray or advanced imaging methods does not improve the health outcomes of patients.

"We need valid, evidence-based performance measures to reduce the overuse of tests and treatments that provide little benefit or might even cause harm," said Amir Qaseem, MD, FACP, PhD, MHA, Director of Clinical Policy, ACP. "Physicians and patients need to work together to pursue care that improves health, avoids harms, and eliminates wasteful practices."

ACP recommends that performance measures should be based on high quality evidence that assess the benefits, risks, and costs of interventions. In addition, data from different types of research designs and methods, including subgroup analyses from clinical trials, cohort studies, cost-benefit analyses, and cost-effectiveness analyses, are needed to develop performance measures for low-value interventions.

Performance measures for use of low-value interventions will likely need to be applied at the group level, such as a hospital or multispecialty group practice because many individual physicians may not see enough patients with the target conditions within the measurement interval to allow reliable measurement of differences in utilization, ACP says in the paper.

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