Intervention to reduce low-value preop tests before cataract surgery

Editor's Note

Reducing low-value testing before cataract surgery was associated with cost savings for financially capitated healthcare systems, but it was also associated with losses for fee-for-service healthcare systems, which could be a barrier to eliminating low-value care, this study finds.

Of 1,054 patients (469 intervention, 585 controls) included in the study:

• Preoperative visits decreased from 93% to 24% in the intervention group and increased from 89% to 91% in the control group.
• Chest x-rays decreased from 90% to 24% in the intervention group and increased from 75% to 83% in the control group.
• Laboratory tests decreased from 92% to 37% in the intervention group and from 98% to 97% in the control group.
• Electrocardiograms decreased from 95% to 29% in the intervention group and increased from 86% to 94% in the control group.

During 12-months follow-up, preoperative visits increased in the intervention group to 67%, but chest x-rays, laboratory tests, and electrocardiograms remained low.

Three-year projections estimated a modest amount of cost savings ($67,241) for the academic medical centers, but losses ($88,151) for fee-for-service health systems.

The findings suggest that interventions in complex health systems will have trade-offs and unintended consequences, which should be monitored and reported, the authors say.