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.
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.
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.
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.
"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," researchers conclude.
- Aaron L. Schwartz, Bruce E. Landon, Adam G. Elshaug, Michael E. Chernew, J. Michael McWilliams. Measuring Low-Value Care in Medicare. JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed.2014.1541
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