Medicare Urged to Look Harder at Value of Services Provided
Written by Editor   
Monday, May 01, 2017 12:34 PM

Medicare Payment Advisory Commission has suggested that spending on “low-value” care (services that don’t help patients or actually do them harm, e.g. unnecessary tests).  On the list is imaging for nonspecific low-back pain occuring at a rate of 12 such procedures per 100 patients.

Several members of the Medicare Payment Advisory Commission (MedPAC) have purported that Medicare should work harder on ferreting out the services it shouldn’t be paying for because they either don't help patients or actually do them harm.

In 2014, Medicare spent anywhere from $2.4 billion to $6.5 billion on these types of services, which are known as “low-value care.” Commission members analyzed Medicare claims data from 2012 to 2014, using 31 measures of low-value care.  Approximately 37% of beneficiaries received at least one low-value service in 2014.  In terms of volume, most of those services fell under two categories -- imaging and cancer screening -- while most of the spending on low-value services came in the areas of cardiovascular tests and procedures, and other surgical procedures. 

Medicare spending on imaging for nonspecific low-back pain -- one of the low-value procedures looked at -- amounted to $232 million in 2014, and occurred at a rate of 12 such procedures per 100 patients. Other low-value procedures included prostate-specific antigen (PSA) screening for men ages 75 or older ($79 million, 9 procedures per 100 patients), colon cancer screening for older adults ($405 million, 8 per 100 patients), and spinal injections for low-back pain ($1.26 billion, 6.6 per 100 patients). Use of low-value care varied greatly by geographic area, the researchers found, with five out of the top 10-highest areas being in Florida. 

The researchers also looked to see whether some of the newer payment models -- such as accountable care organizations (ACOs) -- might result in less use of low-value care. Medicare’s Pioneer ACOs spent 4.5% less on low-value care compared with a control group of providers.  Reforming Medicare’s payment and delivery system -- such as by encouraging formation of more ACOs -- is one idea commissioners could consider recommending as a way to reduce low-value service use. 

"Besides the billions that people are spending, people are being hurt. There is nothing good about getting tests you don’t need and aren’t going to help you feel better,” said one commission member.