Low-Value Musculoskeletal Care: A Growing Concern
The fact that 25%–40% of musculoskeletal (MSK) care spending is wasteful or ineffective1 is concerning enough. But coupled with the knowledge that more than 50% of U.S. adults over 18 are living with an MSK condition2—and these conditions are becoming even more common as the population ages—the potential impact of low-value MSK care is staggering. Not only is it unlikely to help patients get better but it can compound the effects that MSK conditions already have on patients’ lives.
For example, MSK conditions cause more missed workdays than any other major health condition—an average of 10 workdays every year.3 And since low-value care can cause patients to be in pain longer, it can further increase time away from work, family, and everyday activities. In addition, low-value MSK care can lead to increased out-of-pocket costs due to unnecessary copays and other medical expenses.
What is Low-Value MSK Care, and Why Does it Happen?
So why is low-value care recommended by providers at all? First, it’s important to understand that most MSK diagnostic tools and treatment plans are not inherently “low value.” When used appropriately, they’re incredibly effective. What determines the value of care comes down to whether it’s likely to deliver the best outcome for each patient, compared to other evidence-based approaches.
One common example of low-value MSK care is arthroscopic knee surgery for a degenerative meniscus tear, which can happen as people age. Often, a provider will recommend this surgery to look inside the knee and trim the meniscus, but evidence shows that the procedure doesn’t work any better than physical therapy.4
“By having physical therapy instead of knee arthroscopy to treat a degenerative meniscus tear, you can avoid the risk of that surgery, whether it be from the anesthesia or complications from the surgery itself, like an infection or pain,” said Dr. Robert Westergan, EviCore’s Associate Chief Medical Officer of Connected Musculoskeletal Solutions. “For the patient, it allows them to avoid all these potential issues and follow a path demonstrated to have the same or better outcomes than a procedure.”
The challenge for providers is that medical knowledge is advancing at a rapid rate, and it can be nearly impossible to stay up to date with the evidence. More than two-thirds of physicians say they feel overwhelmed by the amount of information they need to keep up with.5 Providers want to offer the best care for their patients, but sometimes knowledge gaps may lead to recommendations for low-value care.
How EviCore’s MSK Utilization Management Solution Helps Prevent Low-Value Care
By staying on the cutting edge of medical knowledge, EviCore’s MSK team of more than 100 surgeons, physicians, chiropractors, and therapists work together to identify low-value care and recommend high-value, evidence-based alternatives whenever possible.
“The medical evidence is what drives our work,” said Dr. Westergan. “It’s at our core.”
Through these efforts, EviCore’s solution not only helps MSK patients reduce risks, lower stress and achieve better outcomes—including reduced pain and increased function, it also helps to reduce overall health care costs, which lowers premium payments and out-of-pocket costs for everyone.
Want to learn more about EviCore’s MSK Utilization Management Solution?
Visit the solution page right here on our website.
Sources
1. Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, García L, & Herrera-Espiñeira C. (2010). “Variability of indication criteria in knee and hip replacement: an observational study.” BMC Musculoskeletal Disorders, 11, Article 249. https://doi.org/10.1186%2F1471-2474-11-249
2. United States Bone and Joint Initiative. (2018). “The Burden of Musculoskeletal Disease in the United States: The Big Picture.” https://www.boneandjointburden.org/2014-report/i0/big-picture
3. United States Bone and Joint Initiative. (2018). “The Burden of Musculoskeletal Disease in the United States: Lost Work Days.” https://www.boneandjointburden.org/fourth-edition/id2/lost-work-days
4. Noorduyn JCA, van de Graaf VA, Willigenburg NW, Scholten-Peeters GGM, Kret EJ, van Dijk RA, Buchbinder R, Hawker GA, Coppieters MW, & Poolman RW; ESCAPE Research Group. (2022). “Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial.” JAMA Network Open, 5(7), Article e2220394. https://doi.org/10.1001/jamanetworkopen.2022.20394
5. Doximity. (2022). Physician Learning Preferences. https://c8y.doxcdn.com/image/upload/Press%20Blog/Research%20Reports/Doximity-Physician-Learning-Report-2022.pdf