@article{TEXTUAL,
      recid = {11298},
      author = {Sanghavi, Prachi and McWilliams, J. Michael and Schwartz,  Aaron L. and Zaslavsky, Alan M.},
      title = {Association of Low-Value Care Exposure With Health Care  Experience Ratings Among Patient Panels},
      journal = {JAMA Internal Medicine},
      address = {2021-05-28},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Importance: Patient reviews of health care experiences  are increasingly used for public reporting and alternative  payment models. Critics have argued that this incentivizes  physicians to provide more care, including low-value care,  undermining efforts to reduce wasteful practices.&lt;/p&gt;  &lt;p&gt;Objective: To assess associations between rates of  low-value service provision to a primary care professional  (PCP) patient panel and patients’ ratings of their health  care experiences.&lt;/p&gt; &lt;p&gt;Design, Setting, and Participants:  This quality improvement study used Medicare  fee-for-service claims from January 1, 2007, to December  31, 2014, for a random 20% sample of beneficiaries to  identify beneficiaries for whom each of 8 low-value  services could be ordered but would be considered  unnecessary. The study also used health care experience  reports from independently sampled beneficiaries who  responded to the 2010-2015 Consumer Assessment of  Healthcare Providers and Systems (CAHPS) Medicare  fee-for-service survey. Statistical analysis was performed  from January 1, 2019, to December 9, 2020.&lt;/p&gt; &lt;p&gt;Main  Outcomes and Measures: The main outcomes were health care  experience ratings from Medicare beneficiaries who  responded to the CAHPS survey from 2 domains, namely “Your  Health Care in the Last 6 Months” (overall health care,  office wait time, timely access to nonurgent care, and  timely access to urgent care) and “Your Personal Doctor”  (overall personal physician and a composite score for  interactions with personal physician). Beneficiaries in  both samples were attributed to the PCP with whom they had  the most spending. For each PCP, a composite score of  low-value service exposure was constructed using the 20%  sample; this score represented the adjusted relative  propensity of the PCP patient panel to receive low-value  care. The association between low-value service exposure  and health care experience ratings reported by the CAHPS  respondents in the PCP patient panel was estimated using  regression analysis.&lt;/p&gt; &lt;p&gt;Results: The final sample had  100 743 PCPs, with a mean of approximately 258 patients per  PCP. Only 1 notable association was found; more low-value  care exposure was associated with more frequent reports of  having to wait more than 15 minutes after the scheduled  time of an appointment (a mean of 0.448 points lower CAHPS  score on a 10-point scale for PCP patient panels who  received the most low-value care vs the least low-value  care). Although some other associations were statistically  significant, their magnitudes were substantially smaller  than those typically considered meaningful in other CAHPS  literature and were inconsistent in direction across levels  of low-value service exposure.&lt;/p&gt; &lt;p&gt;Conclusions and  Relevance: This quality improvement study found that more  low-value care exposure for a PCP patient panel was not  associated with more favorable patient ratings of their  health care experiences.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/11298},
}