The strongest statistical correlation found in the study indicates that low-value care leads to more time spent in the waiting room.
Findings from a new study may assuage concerns that delivery of low-value care is encouraged through the use of patient experience ratings in payment formulas.
For a study published in JAMA Internal Medicine, researchers examined the following in primary care settings:
- Medicare fee-for-service claims spanning 2007 through 2014 among more than 100,000 professionals
- Patient experience reports based on 2010 through 2015 responses to the CAHPS survey, which can factor into payment as a component of the Medicare Shared Savings Program and the Merit-based Incentive Payment System
Relevant services were identified using a previously published methodology that defined low-value services as providing minimal clinical benefit in specific scenarios.
The key findings
Although some associations between exposure to low-value care and CAHPS scores “were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure,” the authors wrote.
If anything, the strongest statistical association indicates that providing low-value care can lead to worse performance on surveys: “More low-value care exposure was associated with more frequent reports of having to wait more than 15 minutes after the scheduled time for an appointment.”
That relationship may arise because “poorly organized or overwhelmed practices substitute wasteful services for higher-value services that require more cognitive effort and clinician time,” the authors theorized.
The bottom line
The authors acknowledged that their study does not show a causal relationship between provision of low-value care and patient experience ratings. Still, their findings “may help reduce the use of low-value care that is provided to appease patients who would be equally satisfied with less wasteful care and help alleviate concerns that patient dissatisfaction should inhibit waste reduction under alternative payment models.”