Issue link: https://beckershealthcare.uberflip.com/i/1462389
37 QUALITY IMPROVEMENT & MEASUREMENT 20 hospitals, health systems that provide the most 'unnecessary' care: Johns Hopkins By Alia Paavola H ealth systems that employed fewer primary care physicians, have higher bed counts or are investor owned were more likely to provide more unnec- essary or low-value care, a study published Jan. 14 in JAMA found. For the study, researchers from Balti- more-based Johns Hopkins University analyzed Medicare claims data from 3,745 hospitals for 17 low-value services. e low-value services were previously identified as unnecessary and included services such as pap smears for women older than 65, an ab- dominal CT scan with and without contrast and spinal fusions for back pain, according to the study. e researchers then rated the hospitals using an overuse index, which was based on the Medicare claims for the low-value healthcare services. Health systems rated at least 1.5 standard deviations or more above the average in the overuse index were con- sidered over-users of low-value services. Below is a breakdown of the 20 hospitals that provided the most unnecessary care based on the overuse index. 1. St. Dominic Health Services (Jackson, Miss.) 2. USMD Health System (Irving, Texas) 3. Community Medical Centers (Clovis, Calif.) 4. Care New England Health System (Provi- dence, R.I.) 5. East Alabama Medical Center (Opelika) 6. Pocono Health System (East Stroudsburg, Pa.) 7. University Health Care System (Augusta, Ga.) 8. Deaconess Health System (Evansville, Ind.) 9. Congregation of the Sisters of St. Joseph of Peace (Englewood Cliffs, N.J.) 10. Iredell Health System (Statesville, N.C.) 11. Sacred Heart HealthCare System (Allentown, Pa.) 12. Southeast Health (Dothan, Ala.) 13. Chesapeake (Va.) Regional Medical Center 14. Butler (Pa.) Health System 15. CarolinaEast Health System (New Bern, N.C.) 16. Ohio Valley Health Services and Education Corp. (Wheeling, W.Va.) 17. Slidell (La.) Memorial Hospital 18. Lakeland (Fla.) Regional Health System 19. North Kansas City (Mo.) Hospital 20. Temple University Health System (Philadelphia) n Study finds significant variations in physicians' treatment plans, care By Gabrielle Masson P hysician care varies widely, with some physicians much more likely to deliver proper care than others, even those working in the same area or organization, according to an analysis published Jan. 28 in JAMA Health Forum. Researchers examined 2016-19 medical insurance records provided in 14 common clinical scenarios by 8,788 physicians from seven different specialties across five metropolitan U.S. areas. Researchers determined whether physicians applied evidence-based guidelines to choices made in common clinical scenarios. "We looked at a set of situations where clear-cut guidelines have been in place for years, with the hope of limiting variation in physician decision-making and promoting the use of the most appropriate care, based on rigorous evidence," said lead author Zirui Song, MD, PhD, associate professor of healthcare policy at Harvard Medical School and general internist at Massachusetts General Hospital, both based in Boston. "In some of the cases we looked at, physicians who made the most clinically appropriate decisions were five to 10 times more likely to use the recommended standard of care than peers in the same specialties and cities whose decisions tended to be the least appro- priate," Dr. Song said. "The differences we found are a cause for concern." The variations are most likely related to individual differ- ences, not differences in health systems, as the variation between individual physicians working in the same organization was greater than the differences in perfor- mance between organizations, according to Dr. Song. Researchers have long suspected that the care variation tied to physicians contributes to U.S. healthcare spend- ing waste, according to Dr. Song, who said, "This study offers evidence that this problem is large and wide- spread across specialties." n