During my annual exam last fall, my physician assistant asked if I’d like to include a Vitamin D test with my lab work. I quickly said yes, thinking that it seemed like a good idea and that I should get everything done at the same time. The very next day, I was reading the Choosing Wisely list of wasteful health care services, and saw Vitamin D tests should be avoided unless you have osteoporosis or a digestive system disease (thankfully, I have neither). Ugh! I was so disappointed in my decision because I was directly responsible for spending unnecessary health care dollars – essentially a sin given the mission of my organization.
A few months later, CIVHC released the first Low Value Care in Colorado report, and I discovered I’m not the only one receiving unnecessary Vitamin D tests. In fact, it was in the top 17 for highest spend low value services for all payers except Medicare Fee-for-Service. I considered myself lucky, however, since other services like certain catheters for patients with chronic kidney disease, and opioids for low back pain, could cause financial, physical and/or mental harm.
As our health care system emerges from the constraints of COVID-19 and we settle into a new normal, it will be more important than ever to ensure we are using the limited resources wisely and only delivering care that truly improves our health. When we look back on the impact of this pandemic, we’ll undoubtedly see an automatic drop in low value care given the current stringent limits and patient fear of accessing the system in general. In terms of reducing low value care and widespread adoption of innovations like telemedicine, experts hope that we’ll continue the positive momentum moving forward.
I’m also hopeful this crisis will help patients understand they can and should play a more active role in supporting our busy health care providers and educating ourselves to become partners in our own care. If I had asked my physician assistant more questions or known about the Vitamin D guidelines, I would have opted not to add the test. Alternatively, in some circumstances, patients and providers may decide a service on the low value care list is appropriate if family history or other confounding health problems exist.
The most important part is to have the conversation and work together. COVID-19 has made us acutely aware that our health and the factors influencing it are complex and multi-faceted. Only by working together will we be successful in making decisions and developing a health care infrastructure that is nimble and efficient to support our needs into the future.