Doing less: Docs change practice patterns following peer pressure

Showing doctors how their unnecessary procedures stack up against their peers might be the golden ticket for reducing healthcare spending, according to a study released Tuesday.

Researchers reviewed how physicians treated vericose veins and a related condition, looking for unnecessary treatment. After clinicians received individualized peer benchmark reports, they performed fewer endovenous thermal ablations per patient. The simple procedure allows blood to flow normally through leg veins.

The study’s findings, published in JAMA Network Open, could translate to even bigger savings by using personalized benchmarks to target outlier physicians and eliminate needless surgeries.

While many hospitals already get benchmarked reports on procedures and costs, those usually involve the average of all the facility’s surgeons combined.

“But the problem with those benchmarking is that a lot of times when physicians look at institutional benchmarking, they’re like, ‘well, that’s not what I’m doing, so this is being driven by somebody else,'” said Caitlin Hicks, a vascular surgeon at Johns Hopkins Medicine and a co-author of the study.

The study researchers tackled endovenous thermal ablations, which have become more popular across the country. Researchers found doctors generally only perform these procedures up to twice on a patient in a year. Outliers performed almost four ablations on a patient in a year.

The American Vein and Lymphatic Society partnered with the researchers in 2018 to send personalized benchmark letters to 1,558 physicians — including 90 outliers — who performed ablations frequently based on 2017 Medicare claims.

Medicare pays a set amount for ablations for one vein and smaller payments for additional veins treated on the same day. However, if a doctor spaces out procedures for a patient over multiple days, they get paid the higher amount each time.

“It’s much more financially lucrative to do this in repeated procedures, as opposed to trying to get everything done in one sitting, although not better for the patient, necessarily” Hicks said. “Everyone agrees that endovenous ablation is a good thing, it’s just a matter of doing it too many times.”

The majority of the outlier physicians substantially reduced their practice of bringing in patients over multiple days. Almost half of them were no longer outliers in 2019 when researchers reviewed claims again. Overall, the targeted clinicians also reduced their ablation use modestly.

The letters resulted in an estimated $6.3 million in Medicare savings, and the study overall cost approximately $25,000. Those results could hold greater promise for healthcare spending, Hicks said.

“I honestly believe if we don’t start policing ourselves as societies, then someone else is going to do it for us, specifically (the Centers for Medicare and Medicaid Services),” Hicks said.

The study researchers plan to expand their research with other overused, medically unnecessary treatments. But pinning down the right metric, and calculating which doctors are outliers, is important, Hicks said.

“Even just in the development of what metrics you use, what can seem like huge practice variation sometimes has a reason behind it,” Hicks said. “So you need to make sure that the metric you’re championing as being a metric of value-based care is actually just that. Because if you just start sending people tons of reports and it’s not a thoughtful metric, then you’ll have no oomph there.”

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