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    Wasteful Care in Medicare 'Substantial and Widespread'

    Medicare beneficiaries "commonly" undergo tests and procedures that are of little benefit and could cost the system more than $8 billion a year, according to authors of a new study of 1.36 million beneficiaries. Though researchers say that the findings are "consistent with the notion that wasteful practices are pervasive in the US health care system," gauging the actual magnitude of the problem—and pinning down costs to Medicare—is not easy.

    The study, published in the May 13 issue of JAMA Internal Medicine (abstract only available for free), analyzes the use of "low value" services in cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing, and surgical procedures by way of 26 claims-based measures applied to Medicare claims from 2009. The services were chosen based on recommendations in the American Board of Internal Medicine (ABIM) Foundation's "Choosing Wisely" campaign, as well as other agencies. APTA is 1 of the first 3 nonphysician groups that will be participating in the Choosing Wisely campaign.

    The 26 services researchers selected for the study "provide little to no clinical benefit on average" and included procedures such as cervical cancer screening for women 65 and older, bone mineral testing at frequent intervals, preoperative stress testing, EEGs for headache, and PSA testing for men 75 years and older.

    Researchers used 2 screening approaches that had different "sensitivity" levels. They found that low-value procedures and tests occurred at the rate of about 80 services per 100 beneficiaries at the more sensitive analysis level, or about 21.9 million instances in 2009.The less sensitive analysis dropped use rate to about 33 services per 100 beneficiaries, with 9.1 million instances experienced by 25% of beneficiaries.

    Depending on the approach used, authors write, the prevalence of low-value services could amount to a per-beneficiary annual cost of either $310 or $71, which translates into Medicare costs of either $8.5 billion or $1.9 billion.

    "Even when applying narrower versions of our limited number of measures of overuse, we identified low-value care affecting one-quarter of Medicare beneficiaries," authors write. "Despite the limited number of services we examined, their frequency and correlations with one another suggest substantial and widespread wasteful care."

    One of the strongest findings of the research, according to the authors, is just how much more work needs to be done to develop a solid approach to analyzing low-value services. "Many quality measures have been developed to assess underuse but few to assess overuse," authors write.

    Research-related stories featured in News Now are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    Three cheers for evidence based practice. This is exactly what is needed to take our practice to the next level of excellence. This is one of the four things needed to fix our present health care system in our country.
    Posted by Ron Knickrehm on 5/23/2014 6:11 PM
    I would be interested in seeing low value defined or clarified.
    Posted by Janet on 5/24/2014 8:44 AM
    Reducing unnecessary procedures is laudible. However, overzealous use of analysis, or ironclad rules about what can be done or not done invalidates the clinical judgement of the provider. There may be times clinically when some of these tests would be appropriate for a patient with specific problems, but would not be appropriate for the population in general. Be careful not to throw the babies out with the bath water. Clinical judgement must be protected or we become cook book technicians blindly following "rules" instead of being professionals analyzing patients and making choices appropriate for this patient.
    Posted by Don Showalter on 5/24/2014 10:20 AM
    I whole heartedly agree with Don Showalter. Medicine is an art, not just clinical pathways created for the "normal/average" person.
    Posted by Ann Dennison on 5/29/2014 3:11 PM
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