The federal government's Medicare program and older adults together spend $4.4 billion annually on care that offers limited clinical value to patients and may even increase their risk of harm, according to a new study.
The research highlights 47 tests, scans, and procedures proven ineffective or potentially harmful for most patients. By reducing the use of these services in individuals unlikely to benefit, Medicare could redirect funding towards more essential care.
Focusing on just five services, which have received a "D" grade from the U.S. Preventive Services Task Force due to being ineffective or posing risks that outweigh benefits, could save $2.6 billion for Medicare and seniors enrolled in the program.
A "D" grade allows the Secretary of Health and Human Services to authorize withholding payment under the Affordable Care Act.
The five services include: screening older adults for chronic obstructive pulmonary disease; screening asymptomatic patients for urinary tract bacteria; testing men over 70 for prostate-specific antigen if they have no personal or family history of prostate issues; and screening older adults without symptoms for carotid artery blockages, neck artery narrowing, or heart rhythm irregularities via electrocardiogram.
The study also identifies 42 additional services classified as low-value by major medical societies based on research. Seventeen of these services, including three in the "D" grade category, account for 94% of low-value care identified in the study.
Health economist David D. Kim, Ph.D., and primary care physician A. Mark Fendrick, M.D., conducted this research as part of federal efforts to curtail Medicare waste and control costs. Their findings were published in JAMA Health Forum().
JAMA Health Forum"We suggest that significant savings can be achieved by avoiding unnecessary tests for patients who would not benefit or could potentially be harmed," stated Kim. He emphasized that the analysis does not include spending on follow-up care resulting from low-value tests like universal PSA screening, which has been estimated to cost $6 for every $1 spent.
Fendrick noted the study relies on clinical evidence distinguishing between patients who would benefit and those who wouldn’t from any of these 47 services.
The researchers scrutinized anonymous Medicare payment data for a random sample of individuals from 2018 to 2020, extending their findings to the entire Medicare population.
"This research is highly relevant to policy as it offers a patient-focused approach to quantifying unnecessary medical spending," noted Fendrick. "It's more refined than blunt government cost-cutting that could harm patients."
He mentioned a section in the Affordable Care Act authorizing Medicare to stop covering low-value preventive services receiving a "D" grade from USPSTF as an example of value-based insurance design, with further details available on the U-M VBID center website.
The complete list of analyzed services and their rankings in total spending and most-used status is available here.