Design and use of performance measures to decrease low-value services and achieve cost-conscious care.

Improving quality of care while decreasing the cost of health care isa national priority. The American College of Physicians recently launched its High-Value Care Initiative to help physicians and patients understand the benefits, harms, and costs of interventions and to determine whether services provide good value. Public and private payers continue to measure underuse of high-value services(for example, preventive services, medications for chronic disease),but they are now widely using performance measures to assess use of low-value interventions (such as imaging for patients with uncomplicated low back pain) and using the results for public reporting and pay-for-performance. This paper gives an overview of performance measures that target low-value services to help physicians understand the strengths and limitations of these measures,provides specific examples of measures that assess use of low-value services, and discusses how these measures can be used in clinical practice and policy.