Opinion: De-adopting Low-Value Care

Evidence, Eminence, and Economics

An often cited shortcoming of the US health care system is the slow pace with which new innovations are adopted into routine clinical practice. A parallel problem receives comparably less attention: the US and other countries are slow to abandon practices that provide little or no benefit to patients.

Despite robust research cataloguing common practices that confer little or no value these practices remain widespread, accounting for an estimated $67 billion in spending annually. For example, estimates suggest that the Centers for Medicare & Medicaid Services (CMS) spends more than $274 million annually on carotid artery disease screening for asymptomatic patients and more than $111 million annually on cervical cancer screening for women older than 65 years. The concept of de-adopting these and other low-value services is embedded in the Less Is More series in JAMA Internal Medicine and in the Choosing Wisely campaign from the American Board of Internal Medicine.