American College of Physicians policy paper offers performance measurement recommendations to help physicians practice high value care

PHILADELPHIA, October 30, 2012 -- 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 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.

"Design and Use of Performance Measures to Decrease Low-Value Services and Achieve Cost-Conscious Care" appears in the October 30 online issue of Annals of Internal Medicine, published by ACP.

About ACP's High Value Care Initiative

ACP launched a High Value Care initiative in 2010 to help physicians provide the best possible care to their patients while simultaneously reducing unnecessary health care costs. ACP defines high value care as the delivery of services providing benefits that make their harms and costs worthwhile.

Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests or treatments have low value because they do not provide enough benefit to justify even their low costs and might even be harmful.

ACP's evidence-based recommendations aim to educate physicians and patients about how to pursue care together that improves health, avoids harms, and eliminates wasteful practices.

About the American College of Physicians

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 133,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.