Medicare Pays Billions for 'Low-Value Care'
Written by Editor   
Tuesday, May 13, 2014 12:39 PM

The Medicare system spent at least $1.9 billion in 2009 and probably much more on "low-value" procedures and tests, such as cancer screening in patients with end-stage renal disease in patients 75 and older, researchers said.  Depending on whether relatively sensitive versus specific measures of low-value care were used, the percentage of overall Medicare Parts A and B spending that went to such services ranged from 0.6% to 2.7%.

Although these figures represented "modest proportions" of the total Medicare budget, the researchers wrote; from one-quarter to more than 40% of all beneficiaries received at least one of the 26 types of low-value service during the 1-year study period.

Because the 26 measures are probably not an exhaustive list of all tests, procedures, and treatments that are unnecessary in older individuals, overuse of such services may be substantially greater.  

The study "highlights the opportunity for eliminating unnecessary care, and we hope that others will use and improve the methods developed by the authors."  They added, "Most important, we hope that development of better measures of low-value care will ultimately spur development of interventions to reduce unnecessary care."

Among the low-value tests identified by the authors:

  • Four were cancer screens. In addition to screening conducted in elderly dialysis patients, these included PSA testing in older men with no prostate cancer history, cervical cancer screening in older women, and colorectal cancer screening in older patients of both sexes.
  • Four other types of diagnostic and preventive screening were included, such as bone mineral density measurement within 2 years of a previous test.
  • Four kinds of preoperative testing were part of the list, such as chest x-rays within 30 days of a low- to moderate-risk noncardiothoracic surgery.
  • Seven imaging tests were on the list, ranging from sinus CT scans for uncomplicated rhinosinusitis to brain MRI scans in patients identified with syncope as the primary diagnosis.

In terms of the number of beneficiaries receiving services deemed low-value, those involving cancer screening and imaging were the most common, accounting for about three-quarters of all claims for low-value services.  In terms of spending, however, cardiovascular testing and procedures accounted for the vast majority when sensitive measures were applied.

When using specific measures, spending on low-value services was split about equally between cardiovascular tests and procedures and imaging tests, which together accounted for some 80% of all low-value spending.  Median spending per beneficiary was $304 (interquartile range $272 to $343) using sensitive measures; the corresponding median for specific measures was not reported.