Who’s really responsible for low value care in hospitals? Private Healthcare Australia CEO points to ‘drivers’ across the health sector

MedTech & Diagnostics News: The Australian Healthcare and Hospitals Association (AHHA) estimates that a substantial portion – up to 30% – of healthcare services may fall into the category of ‘low value.’ These services are not only ineffective but also potentially harmful to the patient and disproportionately expensive.

During a panel discussion, Gillian Giles, Director of Healthcare Variation at the Australian Commission on Safety and Quality in Health Care, Professor Adam Elshaug, Director at the Centre for Health Policy, University of Melbourne, and Dr Rachel David, CEO of Private Healthcare Australia, delved into the contentious topic of low value care plaguing the healthcare system. According to the discussion, this substandard care not only burdens patients with unnecessary medical procedures but also inflicts financial strain on the healthcare system which is grappling with burgeoning waiting lists for essential healthcare services.

Dr David cited several factors as “drivers of low value care”. She provided an example of hip replacement surgery, claiming how the surgeon’s choice of implant that is influenced by medtech company sales incentives can impact the overall value of the procedure.

“Imagine a patient that is a frail. Their goals of surgical treatment have not been discussed appropriately. The clinician uses an implant not based on data from the Australian Orthopaedic Association’s (AOA) national joint replacement registry, but because the surgeon has received a free training course from the medical device rep and the hospital has received a rebate on the basis of purchasing from that supplier.”

She went on to say “During the procedure, there’s a sales rep present who is paid commission based on how much they sell. They are constantly introducing glues, haemostats and sealants into the procedure that wouldn’t otherwise be used. In fact, not all of them are used but the caps are taken off. That toxic waste needs to be disposed of in the environment when there’s no evidence that using it in the first place would have improved the outcome. The patient then spends weeks in rehab during which they contract COVID and are readmitted to hospital. So this is the sort of thing that we’re trying to avoid.

“It’s not just procedures that we know already are probably useless, like arthroscopy of the knee or neuromodulation for the treatment of back pain. It’s also training health professionals and having a sense that everyone in the system is pulling in the right direction to avoid the sort of outcome that I just raised.”

The panellists were pressed for advice on how to enhance the use of data in pinpointing and rectifying undue variances and low value healthcare.

Ms Giles underlined the importance of an organisation’s mission and governance in steering the focus on such critical matters, making it a priority for the entire workforce. By integrating it with risk and strategy, organisational buy-in becomes more likely, paving the way for cohesive efforts across different programs aimed at addressing the issue of low value care.

Dr David echoed the sentiment, acknowledging the availability of tools and analytics such as the Australian Atlas of Healthcare Variation. She stressed the importance of employing these tools to effectively communicate with both clinicians and consumers on the provision of low value care.

Professor Elshaug emphasised the necessity of collaboration across various stakeholders in the healthcare landscape. He debunked the notion that this issue is isolated to a specific sector, stating, “The reason I’ve been so eager to work across all payers and providers is because this is a system-wide issue.” He urged for a unified approach to data, urging everyone to consider the entire patient journey, spanning from primary to tertiary care. Understanding where high and low value care instances occur across this journey is key to addressing the problem comprehensively.

It is crucial to emphasise the need for a diverse range of stakeholders to participate in these discussions, ensuring that those who are likely to challenge the prevailing narrative are given due consideration. In addressing the complex issue of low value care, it is of utmost importance to solicit input from key stakeholders, which should include Royal Australasian College of Surgeons (RACS), Australian Private Hospitals Association (APHA), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Royal Australian and New Zealand College of Ophthalmologists (RANZCO), Medical Technology Association of Australia (MTAA), as well as various patient advocacy groups.

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