Working to Reduce Low-Value Preoperative Testing in Michigan

Why It Matters

Reducing low‑value pre‑operative testing cuts costs, minimizes patient burden, and demonstrates how data‑driven, collaborative quality initiatives can scale improvements across health systems.

Key Takeaways

• Pre‑op testing rates varied 8%‑88% across Michigan hospitals
• Michigan Medicine cut unnecessary tests from 66% to 19% with nudges
• AHRQ grant funds stepped‑wedge trial across 16 hospitals statewide
• Hospital mergers and rotating staff hindered consistent implementation
• Collaborative Quality Initiatives link data, clinicians, and pay‑for‑performance incentives

Pulse Analysis

Low‑value care, especially unnecessary pre‑operative testing, has long been a hidden source of waste in American health care. Routine electrocardiograms or labs before low‑risk procedures such as cataract surgery add little clinical value yet inflate costs and expose patients to needless interventions. National guidelines discourage these tests, but without systematic oversight, hospitals often default to habit or defensive ordering, driving variability and inefficiency.

In Michigan, the Michigan Program for Value Enhancement (MPrOVE) leveraged the state’s robust claims infrastructure to quantify this variation. By comparing Michigan Medicine’s 66% over‑testing rate to a statewide range of 8%‑88%, the team confirmed that practice patterns, not patient risk, drove excess testing. Behavioral nudges—standardized order sets, clinician education, and real‑time feedback—were deployed in pre‑operative clinics, driving the rate down to 19%. This rapid improvement illustrates how granular data, coupled with targeted implementation science, can translate evidence into practice.

Scaling the model, MPrOVE secured an AHRQ grant to test the intervention across 16 hospitals using a stepped‑wedge design. Early lessons highlight the friction of hospital mergers, shifting leadership priorities, and reliance on temporary surgical staff, which dilute educational efforts. Nonetheless, the collaborative framework, supported by pay‑for‑performance incentives, offers a replicable pathway for other states. As health systems seek to meet value‑based care mandates, the Michigan experience underscores the importance of data‑driven QI, cross‑institutional learning, and adaptable strategies to curb low‑value services.