Examples Barriers to High-Value Care A patient with viral…
Examples Barriers to High-Value Care A patient with viral pharyngitis is seen in the office because telephone care is not reimbursed. A patient with a viral upper respiratory tract infection who asks for antibiotics is given a prescription because it takes less time than explaining why the patient does not need antibiotics. Insurance claims data do not account for clinical decision-making based on individual patient characteristics, nor do they assess the quality of the patient experience. A test done at another institution is repeated because the electronic medical records are not interoperable and the results are not available. The attending physician commends the medical student for working up a rare but unlikely diagnosis on the student’s patient. Ordering the additional testing when the patient has a straightforward clinical diagnosis “just to be sure.” Increased hospital admissions for atypical chest pain after a clinician was sued for a bad outcome when they sent a patient with chest pain home from the ED. A desire to please the patient by ordering advanced imaging for low back pain because the patient requests the study. Discomfort with diagnostic uncertainty Patient expectations Local culture and hidden curriculum Imprecise measurements Misaligned financial incentives Fear of malpractice
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