Physicians’ mastery of medical knowledge appears to play a crucial role in curbing the use of low-value healthcare services, a new observational study reveals. Published in JAMA Internal Medicine, the research analyzed data from nearly 900,000 Medicare beneficiaries treated by over 7,000 general internists who undertook the American Board of Internal Medicine’s (ABIM) Internal Medicine Longitudinal Knowledge Assessment (LKA®) during 2022 and 2023. The findings emphasize the connection between physician assessment performance and the likelihood of patients receiving unnecessary tests and treatments that contribute significantly to systemic waste.
The study centered on the correlation between physicians’ LKA scores and their ordering patterns for 25 identified low-value primary care services. Patients under care of doctors ranked in the top performance quartile were nearly 8% less likely to receive one or more of these services compared with those seeing physicians in the bottom quartile. This included marked decreases in diagnostic and preventive testing, cancer screenings, and imaging procedures, which collectively account for a substantial portion of unnecessary medical expenditures in the United States.
Two particularly costly services—triiodothyronine (T3) testing in hypothyroid patients and prostate-specific antigen (PSA) screening in men aged 75 and older—were prominent drivers of these disparities. These tests are known to frequently lead to invasive and often unproductive downstream interventions. The research highlights that higher physician medical knowledge, as evidenced by LKA performance, is associated with more judicious use of these and other low-value modalities, thereby potentially reducing patient exposure to unnecessary risks and the overall healthcare burden.
Notably, the study confirms that low-value service use remains widespread across all levels of physician knowledge, with roughly 30% of patients receiving at least one unnecessary service regardless of their doctor’s assessment results. This underlines the pervasive challenge of eliminating wasteful practices within healthcare systems and suggests that improving physician knowledge is a piece of a complex puzzle involving behavioral and systemic factors.
The LKA, launched in 2022 as an alternative to traditional proctored exams, delivers quarterly question sets over a five-year cycle with detailed feedback, aiming to reinforce up-to-date clinical knowledge and decision-making skills. This approach facilitates ongoing learning rather than episodic testing, allowing closer alignment between physician expertise and evolving standards of care. The study authors posit that continued participation and improvement in LKA performance may translate to further reductions in low-value care, although longitudinal data are needed to confirm this.
Beyond financial implications, reducing unnecessary testing and treatment addresses patient safety concerns related to overdiagnosis, anxiety induced by false positives, and exposure to invasive procedures without clear benefit. The research team underscores that physician clinical knowledge and judgment remain vital levers for enhancing healthcare value, complementing the roles of payers, policymakers, and institutional protocols designed to steer appropriate care delivery.
This study builds upon prior investigations linking higher physician board certification and maintenance of certification examination performance with improved patient outcomes, including reduced hospital readmissions and mortality rates. Together, these findings reinforce the critical importance of continuous professional development and rigorous assessment in fostering evidence-based medical practice.
Looking ahead, the authors advocate for further exploration into how educational interventions tied to longitudinal assessments like the LKA can sustainably shift practice patterns and contribute to system-wide cost containment. As healthcare budgets face mounting pressures, the interplay between physician knowledge, clinical decision-making, and resource utilization emerges as a promising domain for impactful change.
Subject of Research: People
Article Title: Low-Value Services and Longitudinal Knowledge Assessment Performance
News Publication Date: 13-Jul-2026
Web References: https://dx.doi.org/10.1001/jamainternmed.2026.2889
References: Estimated $100 billion annual cost of low-value care – https://pubmed.ncbi.nlm.nih.gov/28971913/
Keywords: Health care, Health care costs
