Reducing “low-value” preop care. Good or bad?

May 28, 2019

An interesting study from JAMA looks at the financial impact of reducing “low-value” preoperative care for cataract patients. Approximately 500 cataract patients from two Los Angeles area academic safety net hospitals were tested. One facility underwent “intervention” whereby a quality improvement and education initiative were undertaken with the goal of reducing overuse of preoperative testing personnel, testing and resources. The second facility had no intervention and served as the control group. Intervention resulted in a dramatic reduction in preoperative visits, chest X-rays and lab tests.  Financial impact for the study hospitals (which operate under a capitated budget) showed modest savings over three years of $67,241. However, the same results extrapolated to a fee-for-service hospital calculated a loss of $88,151 over three years.

EHC NOTE: In this study, the financial impact of what is generally agreed to be evidence-based care (minimizing preoperative testing for cataracts) varies between capitation and fee-for-service facilities. This highlights the confusing and inconsistent financial incentives in the US system. In reality, most hospitals operate with a mix of bundled, DRG and fee-for-service arrangements. To isolate the financial impact of what should be a “no-brainer” intervention, would require a detailed analysis of actual payer mix, reimbursement methodologies and the amount of fee-for-service payments. While we certainly default to providing the most appropriate clinical care – in this case minimizing testing – the payment methodologies should uniformly reward this type of evidence-based care as well.