Study measures low-value care in Medicare, may reflect broad overuse

May 12, 2014

Bottom Line: A substantial number of Medicare beneficiaries receive low-value medical services that provide little or no benefit to patients, such as some cancer screenings, imaging, cardiovascular, diagnostic and preoperative testing, and this may reflect a broader overuse of services while accounting for a modest proportion of overall spending.

Author: Aaron L. Schwartz, B.A., Harvard Medical School, Boston, and colleagues.

Background: Several initiatives have focused on defining low-value health care services. Measuring overuse of such services may be helpful to characterize the potential extent of wasteful care and inform policies to address low-value practices.

How the Study Was Conducted: The authors developed 26 claims-based measures of low-value services and used 2009 claims from more than 1.3 million Medicare beneficiaries to assess the proportion of beneficiaries receiving these services, average per-beneficiary service use and the proportion of total spending connected with these services. The 26 measures included cervical cancer screening for women 65 years and older, CT scanning of the sinuses for uncomplicated acute rhinosinusitis (inflammation of the sinuses), preoperative stress testing and back imaging for patients with low back pain.

Results: Between 25 percent and 42 percent of Medicare beneficiaries received low-value services, which accounted for 0.6 percent to 2.7 percent of overall spending, depending on the level of sensitivity in the measure. The study did not identify specific determinants of wasteful care.

Discussion: "Despite their imperfections, claims-based measures of low-value care could be useful for tracking overuse and evaluating programs to reduce it. However, many direct claims-based measures of overuse may be insufficiently accurate to support targeted coverage or payment policies that have a meaningful effect on use without resulting in unintended consequences. Boarder payment reforms, such as global or bundled payment models, could allow greater provider discretion in defining and identifying low-value services while incentivizing their elimination."

Editor's Note: Developing Methods for Less is More

In a related editor's note, JAMA Internal Medicine deputy editor Mitchell H. Katz, M.D., and colleagues write: "This article highlights the opportunity for eliminating unnecessary care, and we hope that others will use and improve the methods developed by the authors. Most important, we hope that development of better measures of low-value care will ultimately spur development of interventions to reduce unnecessary care."
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(JAMA Intern Med. Published online May 12, 2014. doi:10.1001/jamainternmed.2014.1541. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The authors made conflict of interest disclosures. This work was supported by a variety of grants from different funding sources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact author J. Michael McWilliams, M.D., Ph.D., call David Cameron at 617-432-0441 or email David_Cameron@hms.harvard.edu.

The JAMA Network Journals

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