By NextBestFitFeedback and clinician nudges
Report low-value care rates to clinicians and use EHR alerts.
Cheap feedback to clinicians.
Review ledgerHow this path connects
Addresses
Low-value care and overtreatmentThis path
Feedback and clinician nudges
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Report low-value care rates to clinicians
- Add EHR alerts
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Low-value care and overtreatment
Reporting low-value care rates and using electronic record alerts offers an inexpensive way to discourage low-value care while respecting clinician judgment.
What it creates or worsens
- Solves only part of the problem
Feedback on low-value care rates and electronic record alerts have only small effects.
- Clinician burnout from paperwork and EHR work
Electronic record alerts about low-value care can cause alert fatigue for clinicians.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Low-value care and overtreatment: Low-benefit tests and treatments expose them to harm.
- Health insurers, brokers, and their shareholders
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Taxpayers and public budgets
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Health administration and software vendors
- Clinician burnout from paperwork and EHR work: They supply the record and billing systems used for administrative work.
Who loses
- Hospitals, clinics, and care organizations
- Low-value care and overtreatment: Per-service payments reward additional low-value care.
- Drug and device makers
- Low-value care and overtreatment: They sell devices and tests used in low-value care.
- Doctors, nurses, and other clinicians
- Clinician burnout from paperwork and EHR work: Documentation and insurer paperwork drive burnout and early retirement.
- People with ongoing or specialist care needs
- Clinician burnout from paperwork and EHR work: Paperwork leaves less face time with clinicians.
Where it has been tried
- Choosing Wisely: Modest effects.
- Choosing Wisely (U.S.): Among older Medicare fee-for-service beneficiaries, receipt of at least one of 32 measured low-value services declined from 36.3% in 2014 to 33.6% in 2018, a descriptive trend that does not isolate the effect of voluntary guidelines or clinician feedback.Sources: JAMA Network Open (2021)