Low value care in Medicare

 From Aaron Schwartz and others “Measuring Low-Value Care in Medicare” in the latest JAMA/IM:

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Using a 5% Medicare claims sample in 2010 they note that there are 80 items of “low value” care provided per 100 beneficiaries; this care comprised a little over 2.5% of the total cost of care delivered. Low value was defined by their adaptation of many sources such as the U.S. Preventive Services Task Force. They vary their definitions and demonstrate differences in sensitivity and specificity of their measures. Getting rid of low value care should be easy, right? Wrong. As always, each dollar of savings and efficiency reduces someone’s income by 1 dollar. Their discussion is lengthy and useful in identifying the need to address low value care as well as the difficulties of doing so. And the problem is widespread according to this study:

We also found that, although spending on low-value services varied considerably across regions, spending on low-value services was substantial even in regions where it was lowest. For example, low-value spending at the 5th percentile of the regional distribution of low-value spending was greater than the difference in low-value spending between the 5th and 95th percentiles. This finding suggests potential advantages of direct measurement over relative spending comparisons as a basis for detecting overuse because overuse may be substantial even among more efficient providers.

Movement away from fee for service could help:

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.

The politics will be even harder than the technical challenges, which are hard enough.


About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to Low value care in Medicare

  1. Bob Hertz says:

    No kidding it will be difficult.

    In nations with hard budgets for health care, dialysis for a 90 year old is considered low value health care even if it works perfectly from a medical point of view. “Low value” is instead defined in terms of what other social goods could be provided for the same funds……i.e. greatest good for the greatest number.

  2. castoriehandley says:

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