Penalizing Physicians for Low-Value Care in Hospital Medicine: A Randomized Survey

Low-value services-those for which there is little to no benefit, little benefit relative to cost, or outsized potential harm compared with benefit-persist widely despite professional consensus, guidelines, and national campaigns to reduce them. As policy makers consider financially penalizing physicians to deter low-value services, physician support for such penalties remains unknown. We conducted a randomized survey experiment among physicians to evaluate how the framing of harms from low-value care-in terms of those to patients, healthcare institutions, or society-influenced physician support of financial penalties for low-value care services. Policy support rate was 39.6% overall and highest when the harms of low-value care were framed as costs to society (48.4%). Compared with respondents receiving the "patient harm" version, those receiving the "societal harm" version (adjusted odds ratio [OR] 2.83; 95% confidence interval [CI], 1.20-6.69), but not the "institutional harm" framing (adjusted OR 1.53; 95% CI, 0.66-3.53), were more likely to report policy support. Our results suggest that emphasizing the impact of these harms may increase acceptability of financial penalties among physicians and contribute to the larger effort to decrease low-value care in hospital settings. (C) 2018 Society of Hospital Medicine