Study: Medicare Spent $8.5B on Unnecessary Care

In 2009, Medicare spent as much as $8.5 billion (2.7 percent of total spending) on services deemed to have little or no clinical value, according to a JAMA Internal Medicine study.

Based on evidence-based lists of services that provide minimal clinical benefits, researchers identified 26 low-value services. These services fell into the following categories: low-value cancer screening, low-value diagnostic and preventive testing, low-value preoperative testing, low-value imaging, low-value cardiovascular testing and procedures, and other low-value surgical procedures.

After analyzing 2009 Medicare claims, the researchers found between 25 percent and 42 percent of beneficiaries received low-value services, accounting for 0.6 percent to 2.7 percent of total program spending, depending on the sensitivity and specificity of the measures used in the study.

"Despite their imperfections, claims-based measures of low-value care could be useful for tracking overuse and evaluating programs to reduce it," the study's authors wrote. "However, many direct claims-based measures of overuse may be insufficiently accurate to support targeted coverage or payment policies that have a meaningful effect on use without resulting in unintended consequences. Broarder 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."

More Articles on Healthcare Spending:
4 Talking Points on America's Healthcare Spending
Aligning Physicians Around Lowering the Cost of Care: UPMC's Approach
9 Drivers of High Healthcare Costs in the U.S. 


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