What is Low-Value Care, and Why are We Working to Eliminate it?

Inova is working to eliminate unnecessary and expensive procedures for patients

With health care costs accounting as one of the biggest issues facing consumers, Inova is working vigorously to eliminate unnecessary care proven to be of little or no clinical value, repetitive and expensive for patients. Our mission is to provide world-class healthcare — every time, every touch — to each person in every community we have the privilege to serve. As part of these efforts, Inova has joined a special task force across the Commonwealth of Virginia to reduce utilization of tests and procedures that research shows add limited value in particular clinical circumstances, could lead to potential patient harm and result in the higher total cost of care.  

Leading the charge for Inova is Neeta Goel, MD, Medical Director of Quality and Population Health and a primary care physician board certified in family medicine at Inova Medical Group in Ashburn, Virginia. Dr. Goel represents Inova on the Smarter Care Virginia initiative by Virginia Center for Health Innovation, collaborating with professionals from other Virginia health systems and networks to tackle healthcare waste.

In this Q&A, Dr. Goel explains how these efforts have paid off so far and how patients will benefit.

Q: What types of tests and procedures characterize low-value care?

According to the American Board for Internal Medicine’s Choosing Wisely initiative, there are more than 500 commonly used tests and procedures whose value should be questioned by providers and patients. A common example is vitamin D testing, which is often performed as a routine test, sometimes multiple times a year. Many people have low vitamin D levels that can be corrected by making simple changes; routine testing does not change the treatment advice from the doctor but increases the total cost of care. Other examples include an EKG heart test during a routine preventative visit for someone at low risk for heart disease, or imaging tests such as an X-ray, CT scan or MRI scan for someone with low back pain of short duration and no other red flags indicating serious medical problems

The Smarter Care Virginia initiative specifically focuses on reducing provider-driven low-value tests and procedures, such as routine testing for patients with low risk of a particular health problem, or tests are done prior to performing a low-risk surgery in a medically stable patient.

Q: What prompted Inova and others in healthcare to begin tackling low-value care?

The United States spends more on healthcare than any other nation. One of the major contributors to high costs is overutilization of services. Inova is the leading health system in Northern Virginia, serving more than 2 million people each year. Inova wants to be a good steward of healthcare and is committed to reducing the financial and emotional burden associated with the high cost of care, which makes it challenging for patients to seek care. 

Q: What meaningful changes have resulted so far?

Even before the opportunity came along to take part in the statewide task force, Inova had started educating providers and patients about low-value care. Anytime a doctor orders a test or medication considered of potential low-value, a best practice advisory alert is generated in the patient’s electronic health record asking the provider to reconsider the order based on the evidence presented in the alert. Additionally, several Choosing Wisely recommendations are available in primary care clinics across Inova to guide patients to make wiser healthcare choices. Implementing these changes at Inova has saved an estimated $1.6 million in healthcare costs over the past two and a half years. 

How will these efforts ultimately benefit patients?

With Inova’s focus on streamlining the presurgical tests, patients will see seamless collaboration among physicians surrounding their surgical care. Standardized presurgical testing will reduce the need for multiple visits or tests before surgery. Patients will also notice that certain tests that seem routine but add no clinical value might not be performed unless indicated — either because of symptoms of a suspected disease or for patients with risk of future health problems. We assure that nothing will be missed, and the providers will take the time to discuss why it’s not necessary to perform certain tests. These efforts may also help reduce out-of-pocket costs for patients. At Inova, we are committed to delivering the highest quality care that is safe and effective, while containing the rising healthcare cost.

Inova can provide care for all members of your family. Call 855-My-Inova (855-694-6682) for a physician referral.