A notable number of Medicare beneficiaries receive low-value medical services that may provide little or no benefit to patients, such as imaging, cancer screenings, and cardiovascular, diagnostic and preoperative testing, which may reflect a broader overuse of services while accounting for a modest proportion of overall spending. The authors of a study published in the JAMA Network Journals developed 26 claims-based measures of low-value services and used 2009 claims from more than 1.3 million Medicare beneficiaries.
The research team assessed the proportion of beneficiaries receiving these services, average per-beneficiary service use, and the proportion of total spending connected with these services. According to a Science Daily news report, 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.
The results of the analysis showed that between 25% and 42% of Medicare beneficiaries received low-value services, which accounted for 0.6% to 2.7% of overall spending. The Science Daily news report shows that the study did not identify specific determinants of wasteful care.
The researchers write, “Despite their imperfections, claims-based measures of low-value care could be useful for tracking overuse and evaluating programs to reduce it. 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.”
Sources: Science Daily, JAMA Network Journals