May 13—The provision of minimally beneficial services is widespread among older patients, according to new research.
Harvard researchers searched a large sample of Medicare claims for 26 low-value service measures—as identified by previously published research—and found that these services were provided to 25 percent to 42 percent of Medicare beneficiaries in 2009. And Medicare spent from 0.6 percent to 2.7 percent of its total budget on such services, which included those that ran counter to recommendations of the U.S. Preventative Services Task Force.
J. Michael McWilliams, MD, PhD, of the Department of Health Care Policy at Harvard Medical School and his colleagues published their findings online May 12 in JAMA Internal Medicine.
Using more sensitive measures, the authors found that 42 percent of the Medicare beneficiaries had at least one low-value service, with 21.9 million instances total. Such low-value services spending totaled $8.5 billion across Medicare, or $310 for each beneficiary.
More specific measures showed 25 percent of beneficiaries getting at least one such service, or 9.1 million instances. That spending totaled $1.9 million, or $71 per beneficiary.
The new findings echoed recent initiatives, including the ChoosingWisely campaign by the American Board of Internal Medicine Foundation, that have aimed to reduce the provision of healthcare services that provide little or no health benefit to patients.
Although the findings may bolster arguments that Medicare is bloated by wasteful spending, the authors urged caution.
“Despite their imperfections, claims-based measures of low-value care could be useful for tracking overuse and evaluating programs to reduce it,” McWilliams and his colleagues wrote. “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.”
Instead, they suggested that broader 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.
Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.
Publication Date: Tuesday, May 13, 2014