“Cancer” remains one of the most frightening words a patient can hear from a diagnosing physician, even after decades of cancer research has led to better survival rates. Improved prevention and treatment are among the reason cancer mortality rates have declined as oncologists continue to gain more insight regarding why and when people get cancer. This increased level of understanding has also led to changes in prevention recommendations. After years of encouraging people to have regular screenings for common cancers, some doctors and public health officials have begun to advocate for less frequent screenings. For example, blanket screening of all patients for three of the most common cancers – breast, colon, and cervical – is no longer recommended. Focused screening of patients with specific symptoms or history is now preferred. For these cancers, blanket screening adds costs, but not value, to patient care. In support of patient and clinician decisions regarding cancer screenings, the American Board of Internal Medicine developed its Choosing Wisely® guidelines in 2012 in conjunction with oncology specialists. The guidelines were launched to help physicians, patients, and health care stakeholders think and talk about overuse of health care resources. Unnecessary testing is a key focus of the guidelines. Virginia Health Information has made the MedInsight Health Waste Calculator, which is built on the Choosing Wisely guidelines, available to All-Payer Claims Database (APCD) subscribers to examine the degree of low-value services being ordered. VHHA applied the calculator to common tests ordered in Virginia for colon, breast, and cervical cancer. The numbers of dollars spent on low-value testing is eye-opening. Figure 1 is a Low-Value Dashboard that has eight columns:
- Low-Value Measure Rule: The type of service evaluated by the Health Waste Calculator with results defined as either necessary or low value. Low-Value Measure Rules also briefly outline the criteria for a potentially unnecessary service.
- Total Services Measured: The total number of services that were evaluated for a specific Low-Value Measure.
- Total Members: The distinct number of individuals who received a service that corresponded with a low-value measure rule, regardless of whether or not the service was categorized as low value.
- Low-Value Members: The distinct number of individuals who received a service that corresponded with a low-value measure rule and was categorized as low value.
- Low-Value Services: The total number of services that meet the necessary criteria outlined in the Waste Calculator methodology to be classified as low value.
- Low-Value Allowed: The total value of proxy payment allowed dollars associated with claims classified as low value.
- Average Proxy Cost per Service: The proxy payment allowed dollars associated with claims classified as low value divided by the total number of services classified as low value.
- Quality Index: The number of services classified as necessary divided by the total number of services measured.
Each row lists the low-value test and the conditions under which the test is classified as low value. A modest cost medical test can produce millions of dollars of wasted spending when it is overused. An example is the prostate-specific antigen (PSA) test (Row 2). The test averages $104.75 in payment from an insurer, a sum that is roughly equivalent to the cost of a dinner and a movie date. The test was ordered 123,807 times in 2015 on 116,652 men. In all, $8 million was spent on the testing. Roughly two out of three men received the test unnecessarily. That means $5.2 million in testing costs were wasted because the test provided no benefit to those who underwent it. VHHA is making the analyses available to all its APCD subscribers. Please contact Barbara Brown at firstname.lastname@example.org or 804-965-5722 to learn which tests and procedures can be reviewed. (8/4)