Patients whose physicians scored higher in the first year of the American Board of Internal Medicine's Internal Medicine Longitudinal Knowledge Assessment were significantly less likely to receive low-value healthcare services, which cumulatively cost the U.S. healthcare system an estimated $100 billion each year, according to a Jul. 13 report. The findings, published in JAMA Internal Medicine, highlight an association between greater physician knowledge and lower use of tests and interventions that provide little to no benefit to patients.
The study analyzed data from nearly 900,000 Medicare beneficiaries cared for by 7,089 outpatient general internists who first enrolled in the Internal Medicine Longitudinal Knowledge Assessment in 2022 or 2023. Researchers found that if all general internists utilized low-value services at the rate observed among top-scoring participants, approximately 80,000 fewer Medicare fee-for-service beneficiaries would receive any of these services each year. The differences were largely driven by triiodothyronine testing among patients with hypothyroidism and prostate-specific antigen screening for men aged 75 years and older—two of the most costly low-value tests in the United States.
Despite these findings, use of such services was common across all physician knowledge levels; about 30% of patients received at least one type of low-value modality regardless of their doctor's score on the assessment. The study evaluated use of 25 different services considered to be low-value care, including vitamin D testing without a specific reason, carotid artery disease screening for asymptomatic patients, homocysteine testing in cardiovascular disease cases, and head imaging for uncomplicated headache.
More than 92,000 physicians currently participate in the assessment pathway launched by ABIM in 2022. This pathway is available alongside a traditional one-day proctored exam option and provides quarterly questions over five-year cycles with explanations and journal citations after each question. At cycle's end, participants receive a final pass-or-fail result.
Senior author Bradley Gray said, "This is an extremely rigorous analysis of the association between physicians' clinical knowledge and judgment as measured by a standardized exam, and an outcome that is important to both patients and healthcare systems... we are encouraged to see that physician expertise may be a powerful lever in helping reduce the use of unnecessary and often costly tests and treatments." Additional authors include Bruce E. Landon from Harvard Medical School/Beth Israel Deaconess Medical Center and Weifeng Weng from ABIM.
