Medicare spending on low-value services may cost anywhere from $2 billion to $8.5 billion, depending upon how one defines it, a study found.
Researchers developed a list of 26 claims-based measures of low-value services and applied the criteria to a random 5% sample of Medicare beneficiaries (more than 1.3 million people) for the year 2009. The 26 measures included cervical cancer screening for women 65 years and older, CT scanning of the sinuses for uncomplicated acute rhinosinusitis, preoperative stress testing and imaging for patients with low back pain.
Results appeared online May 12 at JAMA Internal Medicine.
Between 25% and 42% of Medicare beneficiaries received low-value services, depending upon whether researchers applied more sensitive or more specific measures. There were 80 services per 100 beneficiaries detected by the more sensitive measures of low-value services, corresponding to 21.9 million instances for the entire traditional Medicare population, with 42% of beneficiaries receiving at least 1 service detected by the more sensitive measures. More specific but less sensitive measures of low-value care detected 33 low-value services per 100 beneficiaries, corresponding to 9.1 million services for the entire Medicare population, with 25% of beneficiaries receiving at least 1 of these services.
The more sensitive measures of low-value care totaled $8.5 billion, or $310 per beneficiary, while the more specific measures totaled $1.9 billion, or $71 per beneficiary. The more sensitive measure was 2.7% of total annual Medicare Parts A and B spending for 2009; the more specific measure totaled 0.6% of spending.
Corresponding author J. Michael McWilliams, MD, PhD, ACP Member, and colleagues wrote, “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.”
In a related editor’s note, Mitchell H. Katz, MD, FACP, and colleagues wrote: “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.”