Low-value health care drops only marginally despite effort to curb practices

February 16, 2021

Spending on low-value health care among fee-for-service Medicare recipients dropped only marginally from 2014 to 2018, despite both a national campaign to better educate clinicians and increasing use of payment revisions that discourage wasteful care, according to a new RAND Corporation study.

Three items accounted for two-thirds of the low-value care. Among these, prescribing opioids for acute back pain increased despite a growing national awareness of the harms caused by the drugs and the role of such prescribing in fueling the nation's opioid crisis.

The study found that the proportion of study participants receiving any of 32 low-value services decreased from 36.3% in 2014 to 33.6% in 2018. Annual spending per 1,000 individuals on low-value care also decreased, from $52,766 to $46,922 from 2014 to 2018. The findings are published online by the journal JAMA Network Open.

"Our study highlights several promising opportunities for targeted interventions that may reduce wasteful health care spending while improving the quality of care," said John N. Mafi, the study's lead author and an adjunct physician policy researcher at RAND, a nonprofit research organization.

"Given mushrooming deficits and the fact that the Medicare trust fund is running out of cash, there will be enormous pressure to find ways to trim spending in the Medicare program and making significant progress in reducing low value care needs to be a top priority," said Mafi, who also is an assistant professor of medicine at the David Geffen School of Medicine at UCLA.

An estimated 10% to 20% of health care spending consists of low-value care, defined as patient services that offer no net clinical benefit in specific scenarios. These items include many common treatments such as the prescribing of antibiotics for uncomplicated acute upper respiratory infections.

While low-value care increases costs for both patients and health care payers, it also is associated with harmful outcomes for patients. For example, about 1 in every 1,000 antibiotic prescriptions is associated with serious complications that require a patient to visit a hospital emergency department.

To address the problem, the American Board of Internal Medicine Foundation joined with multiple clinician specialty societies in 2012 to create an initiative called Choosing Wisely, designed to encourage physicians and patients to engage in conversations about evidence-based medical practice and the problem of low-value care.

The new RAND study analyzed information about the care received by more than 21 million Americans enrolled from 2014 to 2018 in traditional fee-for-service Medicare, the nation's health insurance program for people aged 65 years and older.

Researchers examined claims-based low-value care measures from the Milliman MedInsight Health Waste Calculator, a software program that highlights care designated as wasteful by the Choosing Wisely campaign and other professional physician society guidelines.

The study found that three services accounted for two-thirds of the low-value care. In addition to opioids prescribed for back pain, the other two services were preoperative laboratory testing and the prescribing of antibiotics for upper respiratory infections.

During the study period, preoperative laboratory testing fell, while increases occurred among both opioid prescriptions for back pain and the prescribing of antibiotics for upper respiratory infections.

Researchers caution that the study reflects a small portion of unnecessary care that is amenable to measurement.

"In the midst of ongoing antibiotic overuse and an opioid overdoes crisis, our findings highlight worrisome trends and underscore an urgent need to improve the quality and safety of care delivered to individuals with Medicare," Mafi said.

The study suggests that policymakers continue efforts to educate both physicians and patients about low-value care and continue with payment reforms that discourage use of the low-value practices. In addition, efforts should increase use of computer-based decision-support tools that can encourage physicians to reduce their use of low-value medical care.
-end-
Support for the study was provided by the federal Agency for Healthcare Research and Quality and the National Institutes of Health.

Other authors of the paper are Rachel O. Reid, Lesley H. Baseman, Scot Hickey, Mark Totten, Denis Agniel and Cheryl L. Damberg, all of RAND, and A. Mark Fendrick of the University of Michigan and Catherine Sarkisian of the David Geffen School of Medicine at UCLA.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.

RAND Corporation

Related Antibiotics Articles from Brightsurf:

Insights in the search for new antibiotics
A collaborative research team from the University of Oklahoma, the Memorial Sloan Kettering Cancer Center and Merck & Co. published an opinion article in the journal, Nature Chemical Biology, that addresses the gap in the discovery of new antibiotics.

New tricks for old antibiotics
The study published in the journal Immunity reveals that tetracyclines (broad spectre antibiotics), by partially inhibiting cell mitochondria activity, induce a compensatory response on the organism that decreases tissue damage caused during infection.

Benefits, risks seen with antibiotics-first for appendicitis
Antibiotics are a good choice for some patients with appendicitis but not all, according to study results published today in the New England Journal of Medicine.

How antibiotics interact
Understanding bottleneck effects in the translation of bacterial proteins can lead to a more effective combination of antibiotics / study in 'Nature Communications'

Are antivitamins the new antibiotics?
Antibiotics are among the most important discoveries of modern medicine and have saved millions of lives since the discovery of penicillin almost 100 years ago.

Hygiene reduces the need for antibiotics by up to 30%
A new paper published in the American Journal of Infection Control (AJIC), finds improved everyday hygiene practices, such as hand-washing, reduces the risk of common infections by up to 50%, reducing the need for antibiotics, by up to 30%.

Antibiotics: City dwellers and children take the most
City dwellers take more antibiotics than people in rural areas; children and the elderly use them more often than middle-aged people; the use of antibiotics decreases as education increases, but only in rich countries: These are three of the more striking trends identified by researchers of the NRW Forschungskolleg ''One Health and Urban Transformation'' at the University of Bonn.

Metals could be the link to new antibiotics
Compounds containing metals could hold the key to the next generation of antibiotics to combat the growing threat of global antibiotic resistance.

Antibiotics from the sea
The team led by Prof. Christian Jogler of Friedrich Schiller University, Jena, has succeeded in cultivating several dozen marine bacteria in the laboratory -- bacteria that had previously been paid little attention.

Antibiotics not necessary for most toothaches, according to new ADA guideline
The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches.

Read More: Antibiotics News and Antibiotics Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.