week 2 field work 1

Field Experience Log #1

Title of Event / Sponsors: Meeting of the Market Oversight and Transparency Committee / Low-value care / Massachusetts Health Policy Commission.

Preparation Steps Taken: Prior meeting minutes provided by Dr. David Cutler, chairman of the committee which includes focusing on the Evaluation of market changes (e.g., MCNs/CMIRs), Benchmark establishment and monitoring, Performance Improvement Plans (PIPs), Post-transaction reviews, Registration of Provider Organizations (RPO), Research (e.g., pharmaceutical spending, out of network billing, facility fees, provider price variation)

Place / Date / Time / Length: 50 Milk Street, 8th Floor Boston, MA 02109 / January 14, 2020 / 9:30 / 1.5 hours

Topic Under Discussion: Variation in Performance Among Massachusetts Provider Organizations, Trends in Hospital Outpatient Spending, REDUCING ADMINISTRATIVE COMPLEXITY. Names of Participants and Their Titles: Dr. David Cutler (Chair), Mr. Timothy Foley, Mr. Richard Lord, Mr. Renato Mastrogiovanni, Secretary Michael Heffernan or Designee

Brief Description of the Testimony / Meeting / Event: Massachusetts Health Policy Comission (HPC) Board’s aim is to improve quality and patient protection, while focusing on Cost Trends and Market Performance, how care is delivered and Payment System Transformation including Community Hospital Investment and Consumer Involvement. The committee’s oversees Market Oversight and Transparency andCare Delivery Transformation, with the duties and focus areas as described and the appointments as made by the Chair.

Description and Analysis of the Health Policy Issue and Its Implications for Health Care:

The health Policy issue in this meeting was more focused on the low value care given to patients. According to Badgery-Parker, T. et al. (2019), A low-value care is a care that is not expected to provide a net benefit. This includes diagnostic tests and interventions that their benefit does not outweigh the harm and or cost. During the meeting, it was mentioned and enumerated that Low-value care is the care that is unnecessary. For example, when a patient has a surgery indicated, part of the requirement is for the PCP to do some series of tests called the “preop”. Interestingly some of these tests are not necessary, but most doctors perform the test regardless because the surgeon will not go ahead to do the procedure unless the test is done. As a result, most baseline labs done for pre-operative testing is unnecessary.

On average, more than one in four patient received unnecessary pre-operative tests. Therefore, minimizing care that provides little benefit (ie, low-value care) has become an important focus for decreasing health care costs and improving the quality of care delivery. A key target for low-value care is emergency department (ED) diagnostic imaging overuse Cohen, E. et al. (2019). In addition, at the meeting, When the Highlight of provider organization performance variation was analyzed, they found out that according to statistics, there is large variation in total spending equivalent to a large amount of variation in ED visit. Also, the rate of low value screenings increases with an overall large number of patients receiving unnecessary care. This statistic varies by provider groups. Mr. Renato Mastrogiovanni, who is one of the committees at the meeting, stated that from the data they have gathered, Commercial impatient spending grew 11% more despite the fewer patient. This is because prices for a given stay increased 2-3% per year and severity or acuity of stays increases 2-3% per year which is narrowed down to low-value care (unnecessary spending).

According to Krimphove E. et al. (2019), They were able to identify from their analysis that there is low-value care in men diagnosed with prostate cancer (PCa) and the contribution of the hospitals in this specific case were investigated towards overtreatment in the United States as a whole. Hence, highlighting the probability of overtreating prostate cancer patients across hospitals. Hospitals investigated includes Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA amongst others. After the investigations, they realized that there is wide hospital-level variability in low–value treatment of men with limited life expectancies and low–risk PCa. Hospitals more likely to treat men with limited life expectancies were more likely to treat men with low-risk PCa and vice versa. Identifying drivers and modifying practice at these hospitals may represent an effective tool for reducing overtreatment. Krimphove E. et al. (2019)

According to Madrid, R. A., & McGee, W. (2019), It is a thing of concern for the management of Limited health-care resources as the prevention of low-value care is becoming a recognized topic that affects all providers. Strategies are put in place so that decisions would be made wisely with the patient’s best interest.

During the meeting, in response to this major concern, a “Stop the pre-op campaign” has been currently set in motion but not yet fully established hoping to eradicate unnecessary spending on diagnostic tests, and low-value care. In conclusion, “Identifying drivers and modifying practice at these hospitals may represent an effective tool for reducing overtreatment.” Krimphove E. et al. (2019).

I have been reading a lot about cost and quality in health care. Personally for me, from the standpoint of a provider, it could be a very dicey situation in as much as we want to prevent and avoid litigation, follow the rules and regulations to the book, there is another part of me that feels like there needs to be some sort of regulation from the Health Care Policy System. Hence the reason for continuous meetings where committees come together to tackle Healthcare Policy issues. From this meeting, my take home is that if there could be some sort of regulation from the insurance using guidelines to help channel the needs of each patient in the right direction, just maybe the spending cost will be somewhat regulated. While some may need some diagnostic test for a particular preop maybe based on preexisting conditions or history, some other patient might not. At the end of the day, I would take a stance with quality healthcare (which is in the best interest of the patient) than low-value healthcare.

References

Badgery-Parker, T., Feng, Y., Pearson, S.-A., Levesque, J.-F., Dunn, S., & Elshaug, A. G. (2019). Exploring variation in low-value care: a multilevel modelling study. BMC Health Services Research, 19(1), 345. https://doi.org/10.1186/s12913-019-4159-1

Cohen, E., Rodean, J., Diong, C., Hall, M., Freedman, S. B., Aronson, P. L., … Neuman, M. I. (2019). Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada. JAMA Pediatrics, 173(8), e191439. https://doi.org/10.1001/jamapediatrics.2019.1439

Krimphove, M. J., Cole, A. P., Friedlander, D. F., Nguyen, D.-D., Lipsitz, S. R., Nguyen, P. L., … Trinh, Q.-D. (2019). The current landscape of low-value care in men diagnosed with prostate cancer: what is the role of individual hospitals? Urologic Oncology, 37(9), 575.e9-575.e18. https://doi.org/10.1016/j.urolonc.2019.04.001

Madrid, R. A., & McGee, W. (2019). Value, Chronic Critical Illness, and Choosing Wisely. Journal of Intensive Care Medicine (Sage Publications Inc.), 34(8), 609–614. https://doi.org/10.1177/0885066618790942