"While we found a wide range of low-value care across physician patient panels, there was no systematic association between low-value care exposure and favorable patient ratings," said Sanghavi. "So the physicians whose patients get more low-value care are not getting higher ratings."
These results, the investigators say, should help ease the concern that reducing the number of unnecessary care offerings will negatively impact patients' opinions of their physicians or healthcare organizations.
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"In short, the concern is overblown," said study co-investigator Michael McWilliams, Professor of Health Care Policy at Harvard Medical School and a general internist at Brigham and Women's Hospital. "Whether it's because less wasteful physicians are adept at informing patients why a requested test or procedure is unnecessary, or because most low-value care is due to provider practice patterns and not patient demand, we should be reassured that we can tackle waste in the system without great patient backlash or flunking providers on their 'scorecards.'"
The researchers said they weren't surprised by the findings, since previous studies relied so heavily on anecdotal evidence.
"In fact, it is not settled whether patients even advocate for low-value services," Sanghavi said. "Either way, it is reasonable to imagine patients base their experience ratings on a range of quality dimensions and not just on how well their physicians give in to demands, should they be making them."
Understanding how patient experiences and ratings are impacted by the types of care they receive has important implications for future policies and funding models geared at reducing wasteful healthcare spending while improving the overall quality of care.
"These results should help alleviate the stress that physicians may feel around possibly leaving patients dissatisfied because they didn't do something the patient asked for," said Sanghavi. "It should also relieve pressure to provide unnecessary care in order to boost ratings."
The study, "Association of Low-Value Care Exposure with Health Care Experience Ratings Among Patient Panels," was supported by the National Institute for Health Care Management Foundation and the National Institute on Aging (P01AG032952). Additional authors include Aaron L. Schwartz of the Perelman School of Medicine and Alan Zaslavsky of Harvard Medical School.