Eliminating routine but low-value preoperative tests for cataract surgery patients associated with cost savings

April 15, 2019

FINDINGS

UCLA researchers found that eliminating routine but unnecessary procedures before people undergo cataract surgery has the potential to save costs and resources for hospitals serving lower-income patients.

Forgoing routine chest x-rays, electrocardiograms and other preoperative procedures -- which studies have found to have no clinical benefit prior to cataract surgery -- was associated with a savings of $67,241 over three years at one of the medical centers analyzed in the study. The change was also associated with other benefits - for instance, one licensed vocational nurse had approximately 70 percent more time to pursue other clinical work. The researchers did not detect any measureable negative effects for patients associated with the change.

BACKGROUND

A 2000 study in the New England Journal of Medicine found that routine preoperative tests for cataract surgery are of limited medical value for patients, but a later study, published in the same journal in 2015, found that the procedures are still commonly performed across the U.S. health care system.

METHOD

The researchers compared preoperative testing and costs for people undergoing cataract surgery at two major academic safety net hospitals run by the Los Angeles County Department of Health Services, between April 2015 and April 2016. They also analyzed patients' follow-up reports for an additional year to assess whether eliminating the preoperative care had a sustained result.

IMPACT

"As health systems, policymakers and payers across the United States face mounting pressure to safely lower health care spending, these findings highlight one potential clinician-led approach associated with reduced low-value care, lower costs and improved quality in the safety net health system setting," said Dr. John Mafi, an assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and the study's lead author.

These findings should be of interest to others across the nation interested in improving the value of health care, and it will be important for others to replicate these methods in a randomized controlled trial.
-end-
AUTHORS

In addition to Mafi, the study's other authors are Dr. Catherine Sarkisian, Sitaram Vangala, Carmen Carrillo and Dr. Joseph Ladapo of UCLA; Dr. Emmett Keeler and Dr. Cheryl Damberg of RAND Corporation; Patricia Godoy-Travieso, Dr. Eric Wei, Dr. Malvin Anders, Dr. Rodolfo Amaya, Laura Sarff and Dr. Jesse Berry of Los Angeles County-USC Medical Center; and Dr. Lauren Daskivich of the Los Angeles County Department of Health Services and Harbor-UCLA Medical Center.

JOURNAL

The study was published in JAMA Internal Medicine

FUNDING

The study was funded by the American Board of Internal Medicine Foundation, the National Institutes of Health's National Center for Advancing Translational Science Institute, the National Institute on Aging, and the Agency for Healthcare Research and Quality.

Media Contact:

Enrique Rivero
310-267-7120
erivero@mednet.ucla.edu

University of California - Los Angeles Health Sciences

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.