The American Medical Association defines “low-value” care as medical services that have the potential to harm patients or that may have less expensive substitutes. To investigate the effects of such services, researchers homed in on electrocardiograms performed before cataract surgery. This type of eye surgery is elective and low-risk, and evidence shows routine preoperative testing, such as EKGs, doesn’t improve outcomes and can often lead to more testing.
The researchers found patients who had EKGs before cataract surgery experienced between five and 10 more “cascade events,” or additional services related to the EKG. These included additional testing, new diagnoses, cardiac catheterizations and cardiac specialist visits.
Cumulatively, this cascade of care cost 10 times more than the amount of the initial EKG. While cascades were relatively rare — just 11.3 percent of more than 110,000 cataract surgeries involved preoperative EKGs, and of those, just 16 percent had a cascade event — the results were costly. Researchers found patients who did EKGs incurred $565 each in cascade care, or an estimated $35 million in additional care annually across all Medicare beneficiaries, in addition to the $3.2 million for the testing.
“Our work demonstrates that low-value services that appear financially benign may have large downstream consequences; we should consider these cascades when measuring the consequences of low-value care and prioritizing efforts to reduce it,” the authors wrote.
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