What Are Low Value Heath Care Services?


The tough part about being a doctor is doing what seems right versus doing what is deemed, at least for the moment, right.  This article intrigues me because it discusses the issue of what is called “low-value” health care services.  They supposedly “run up costs, but aren’t always very helpful.”  So which ones are they talking about?  Here are some:

  1. Hormone tests for thyroid problems
  2. Imaging for low-back pain
  3. Imaging for uncomplicated headache

Let’s take the contrarian view for a moment.  I actually screen for thyroid disease.  A TSH is only $10 in my office and I found a ton of thyroid issues in my patients.  Autoimmune disease seems to be exploding but I will leave that alone for now.  Why aren’t we screening for thyroid disease now?  I guess because the USPSTF at this time doesn’t recommend it probably because it is much costlier in other offices and insurers don’t want to pay that cost. Are there many false positive high TSH levels on tests?  Not really and a retest in a few months won’t fiscally hurt if it is only $10.  In other words, since I can keep the test cost low does that take it out of the low value category?  I believe it would.  Other offices charging $100 can’t get away with ordering it. So people go unscreened.  Does that matter?  Well, ask the woman I just found with a TSH of 48 who was thin and no other major thyroid symptoms.  How many others will be missed just because doctors or hospitals want to charge so much for a lab?

I get that X-rays and CT scans come with risks and so I understand that over imaging is an issue. My problem is when we get too aggressive with grading out the things we do and it ends up calling everything a low value service. Pretty soon they will be calling the yearly physical a low value service.  Oh, yeah, they already are.



Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “What Are Low Value Heath Care Services?

  1. Thomas Guastavino
    September 5, 2016 at 6:02 am

    As an orthopedist I have to make a comment about low back pain imaging. It’s the history and the associated symptoms that determine if and what should be the appropriate course of action. Just three examples:
    1) 75 yo female, acute onset LBP while standing at sink: Dx-Osteoporotic compression fracture Imaging: Lateral thoraco-lumbar spine X-Ray and MRI/Bone Scan if looks negative
    2) 35 yo male, LBP 24 hrs after lifting heavy object: Dx-Lumbar Sprain. Imaging: can wait unless symptoms continue
    3) 35 yo male, LBP 24 hrs after lifting heavy object plus numbness/tingling to leg and loss of reflex Dx: Acute HBP, Imaging: Immediate MRI
    The best way to get the most appropriate test is to get the patient to the provider most familiar with the condition. We are going in the opposite direction.

    • Steve O'
      September 5, 2016 at 9:33 am

      “The best way to get the most appropriate test is to get the patient to the provider most familiar with the condition. We are going in the opposite direction.”
      The lowest-cost healthcare intervention – by far – is to get the patient before a competent provider with sufficient time and freedom to obtain a history and examine the patient. It’s decades of experience – provided for free, nearly.
      I find patellofemoral arthritis all the time. It’s a common cause of knee pain. I’ll examine a knee, discuss the positive patellar findings and the negative findings of derangement within the knee. The patient will insist upon an MRI “just to take a look.” That is the highest cost driver – testing that is intended to satisfy WebMD. I’ll insist that I have ALREADY “taken a look.” Patients grouse and complain, and threaten to tell my boss.
      What will we find further down the road? Well, ask first – what direction are we going?

      • Thomas Guastavino
        September 5, 2016 at 7:56 pm

        And grousing patients lead to bad anonymous patient satisfaction scores. No win situation.

    • Perry
      September 5, 2016 at 1:56 pm

      Let docs practice the way they are supposed to . Problem is, patient expectations and the legal system.

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