Reducing Low-Value Care and Ordering Tests Wisely

Not all care helps, and some actively harms. Low-value care, meaning tests, treatments and procedures that provide little or no benefit for a given patient and sometimes cause harm, is a well-documented problem across medicine. The unnecessary imaging that leads to an incidental finding and a cascade of follow-up, the antibiotic for a viral illness, the routine test that changes nothing.

Reducing it is not about rationing or cutting corners. It is about doing more of what helps and less of what does not, which is better for patients and, increasingly, better for practices operating under value-based arrangements. Clinical decisions are always individual; this is about the general discipline, not specific recommendations.

Why low-value care matters

• Patient harm. Unnecessary tests and treatments carry real risks, from the direct harms of a procedure to the cascade of follow-up an incidental finding triggers.
• Cost. Low-value care wastes money: the patient’s, the system’s, and, under cost-accountable arrangements, the practice’s.
• Patient experience and trust. Patients increasingly value clinicians who help them avoid unnecessary care, and over-testing can erode rather than build trust.
• Focus. Time and resources spent on low-value care are not spent on the high-value care that actually helps.

Why low-value care persists

• Just to be safe. Defensive ordering, a test ordered to avoid the small chance of missing something or out of liability worry, is a major driver.
• Patient expectations. Patients sometimes request tests and treatments that are not indicated, and it is easier to acquiesce than to explain.
• Habit and routine. Some low-value care is simply the way it has always been done: routine orders no one questions.
• Fragmentation. Without a full picture, clinicians reorder tests already done elsewhere or miss that something is not needed.
• Time pressure. Explaining why a test is not needed takes longer than just ordering it.

How to reduce low-value care

Foster a high-value mindset

The foundation is a culture that asks whether this will actually change management or help this patient before ordering. Framing it as high-value care, doing what helps, is more motivating than cutting anything.

Use evidence and decision support

Well-designed clinical decision support can surface relevant evidence and guidelines at the point of ordering, gently prompting when something may be low-value, without becoming alert fatigue. The key is thoughtful, not noisy, support.

Communicate with patients

Much low-value care is driven by patient expectations, so the skill of explaining kindly and clearly why a test is not needed is central. Patients who understand the reasoning usually accept it, and appreciate a clinician looking out for them. This connects directly to health literacy and to deciding together.

Have the full picture

A complete view of the patient, including tests already done elsewhere, prevents duplicate and unnecessary ordering. Fragmentation drives waste; connected data reduces it.

Look at your own patterns

Data on ordering patterns, showing where you or your practice may be over-ordering relative to peers or evidence, makes low-value care visible so you can address it. You cannot reduce what you do not see.

The value-based angle

Reducing low-value care used to be purely an ethical and quality matter; increasingly it is also a financial one. Under value-based and cost-accountable arrangements, unnecessary care that does not help the patient also costs the practice, aligning the incentives so that doing the right thing and doing well financially point the same direction.

This is one of the genuinely positive shifts value-based models create: they reward the high-value care good clinicians want to practise anyway. For practices moving toward these models, building the discipline is both good medicine and good business.

How your platform helps

Reducing low-value care depends on having the full picture, good decision support and visibility into patterns, all of which your systems shape. Strong interoperability gives clinicians a complete view, including tests and results from elsewhere, so they do not reorder what has already been done. Thoughtful, well-tuned decision support can surface relevant evidence at the point of ordering without drowning clinicians in alerts. Better information makes ordering wisely the easier path, while the clinical decision always remains the clinician’s.

Frequently asked questions

What is low-value care?

Low-value care refers to tests, treatments and procedures that provide little or no benefit for a given patient and sometimes cause harm, such as unnecessary imaging that triggers a cascade of follow-up, antibiotics for viral illnesses, or routine tests that do not change management. Reducing it is not about rationing; it is about doing more of what helps and less of what does not.

Why do clinicians order unnecessary tests?

Common drivers include defensive ordering to avoid missing something or out of liability concern, patient expectations for tests that are not indicated, habit and routine, fragmentation that leads to reordering tests already done elsewhere, and time pressure that makes ordering faster than explaining why something is not needed. Addressing low-value care means tackling these underlying drivers.

How can a practice reduce low-value care?

Foster a high-value mindset that asks whether an order will actually help the patient, use thoughtful rather than noisy decision support to surface evidence at the point of ordering, and build the communication skill of explaining kindly why a test is not needed. Ensure clinicians have the full picture including outside results, and review ordering-pattern data to make overuse visible.