Research seeks to pinpoint health system characteristics associated with the tendency to ‘overuse’ healthcare

Health plan ownership and participation in value-based payment models did not appear to correlate with lower overuse.

Higher bed counts, fewer primary care physicians and investor ownership are among the characteristics of health systems that tend to provide unnecessary healthcare services, according to a new study.

For a study published in JAMA Health Forum, researchers with Johns Hopkins University examined 17 types of low-value services that took place at 3,745 hospitals and affiliated outpatient sites. The facilities were associated with 676 health systems, and the services were provided to Medicare beneficiaries in 2015-18. Most of the 17 services were screening or imaging for specific conditions.

Among noteworthy results:

• Bed count was one of the characteristics most strongly associated with overuse.
• Having a teaching hospital was associated with less overuse.
• Higher numbers of primary care physicians were associated with less overuse, but higher numbers of medical groups were associated with more overuse.
• Investor-owned health systems “were markedly overrepresented in the highest overuse categories.”
• Higher levels of uncompensated care were associated with less overuse.
• Health plan ownership was not associated with more or less overuse, nor was participation in federal value-based payment models.

The researchers based their findings on their previously created Overuse Index, which was designed to measure overuse by providers at a regional level and since has been updated to include ICD-10 codes and adapted to offer system-level insights.

The health systems were grouped into five categories, where systems in the lowest tier provided the least amount of low-value care relative to the mean.

“The health systems that we expected to be lower in overuse, specifically those that are integrated healthcare delivery systems, were indeed lower in overuse,” the researchers wrote, citing Kaiser Permanente as an example. They also mentioned University of Utah Hospitals and Clinics and Intermountain Healthcare as “systems which are known for their attention to high-value care” and were found to be in the lower tiers of overuse.

Others in the low-overuse categories included “health systems that we suspect are under-resourced,” i.e., large public and safety-net hospitals.