David W. Baker, MD, MPH; Amir Qaseem, MD, PhD, MHA; P. Preston Reynolds, MD, PhD; Lea Anne Gardner, PhD, RN; Eric C. Schneider, MD, MSc; on behalf of the American College of Physicians Performance Measurement Committee*
Financial Support: Financial support for the development of this paper comes exclusively from the American College of Physicians operating budget.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0480.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Baker: Feinberg School of Medicine, 750 North Lake Shore Drive, Chicago, IL 60611.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Reynolds: University of Virginia, PO Box 800761, Charlotesville, VA 22908.
Dr. Gardner: ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.
Dr. Schneider: RAND, 20 Park Plaza Boston, MA 02116.
Author Contributions: Conception and design: D.W. Baker, A. Qaseem, P.P. Reynolds, L.A. Gardner.
Analysis and interpretation of the data: A. Qaseem, P.P. Reynolds, L.A. Gardner.
Drafting of the article: D.W. Baker, A. Qaseem, L.A. Gardner.
Critical revision of the article for important intellectual content: A. Qaseem, P.P. Reynolds.
Final approval of the article: D.W. Baker, A. Qaseem, P.P. Reynolds, E.C. Schneider.
Collection and assembly of data: A. Qaseem, E.C. Schneider.
Baker DW, Qaseem A, Reynolds PP, Gardner LA, Schneider EC, on behalf of the American College of Physicians Performance Measurement Committee*. Design and Use of Performance Measures to Decrease Low-Value Services and Achieve Cost-Conscious Care. Ann Intern Med. 2013;158:55-59. doi: 10.7326/0003-4819-158-1-201301010-00560
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Published: Ann Intern Med. 2013;158(1):55-59.
Improving quality of care while decreasing the cost of health care is a national priority. The American College of Physicians recently launched its High-Value Care Initiative to help physicians and patients understand the benefits, harms, and costs of interventions and to determine whether services provide good value. Public and private payers continue to measure underuse of high-value services (for example, preventive services, medications for chronic disease), but they are now widely using performance measures to assess use of low-value interventions (such as imaging for patients with uncomplicated low back pain) and using the results for public reporting and pay-for-performance. This paper gives an overview of performance measures that target low-value services to help physicians understand the strengths and limitations of these measures, provides specific examples of measures that assess use of low-value services, and discusses how these measures can be used in clinical practice and policy.
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Ron Levy, MD
January 9, 2013
The first step in addressing the high cost of health care should be decreasing use of interventions that provide little or no benefit and are of low value.
An alternate view is that whether an intervention provides little benefit and is of low value may depend on whether a patient's life is saved or prolonged by the intervention.
A benefit from the high cost of health care is the high value of lives saved and disabilities averted. Just as the cost of medical research may be justified by successes, so may the cost of diagnostic tests and screenings.
Instead of coping with the high cost of health care by reducing that costand reducing the survivals that tests may facilitate, a better economy might be to save on such costs as smoking, alcohol, soft drinks, advertising and free lunches provided by sales representatives.
Perhaps the use of diagnostic tests, like the use of vitamin supplements, smoke alarms, costly homes and new cars should be decided by an informed public rather than by experts.
Healthcare Delivery and Policy, High Value Care, Prevention/Screening.
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