In 2017, Virginia clinicians provided $747 million worth of wasteful services to patients, according to the Virginia Center for Health Innovation.
Those services ranged from ordering tests and images before low-risk surgeries to unnecessarily screening for vitamin D deficiencies.
“It delays care, because people have to have those procedures and wait for the results,” said Beth Bortz, president and CEO of the Virginia Center for Health Innovation, or VCHI. “Some of those services can be potentially harmful, too.”
The tests can take an unnecessary toll on the patients, who may anxiously wait for the results or even receive a false positive.
VCHI this month received a $2.2 million grant to tackle unnecessary medical spending in Virginia from Arnold Ventures, a private foundation that states it is “dedicated to improving lives through evidence-based solutions.”
The three-year grant will fund VCHI’s work with six participating health systems: Ballad Health, Carilion Clinic, HCA Virginia, Inova Health System, Sentara Healthcare and VCU Health System.
By using data from Virginia Health Information, which runs the state’s All Payer Claims Database, VCHI will look at the numbers for those six systems by clinician, run reports using a tool that calculates wasteful spending and send those reports to each of the systems so they can evaluate and address the problems.
“Part of what we’re hoping to learn is how they do it,” Bortz said. “Maybe VCU will do this differently than Sentara.
“We’re the first to try to take data and do something meaningful with it,” she added. “We will be the ones, good or bad, learning the lessons about how hard this is.”
There are a variety of reasons why clinicians continue to order tests that are proven to be unnecessary — including misinformation and pure habit.
Take pap smears, for example. Ten years ago, Bortz said, the best practice was for a woman to receive a pap smear every year. Now, evidence shows they’re really only necessary once every three years for a healthy woman who has no risk factors.
“But you still have consumers coming in and asking for their annual pap, and you still have some providers who will just order an annual pap,” Bortz said.
The grant work will focus on seven measures that VCHI chose because they’re largely driven by providers — rather than a wasteful test that a patient might request.
The biggest thing they’ll be looking for, Bortz said, are unnecessary imaging tests, like if a doctor orders an electrocardiogram test before performing cataract surgery, even though the patient has no history of heart problems.
“All eyes are now on Virginia because, if successful, we could serve as a national model for improved value in health care spending,” Sen. Mark Warner said in a news release.