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Study measures wasteful tests in Medicare, includes imaging

by Loren Bonner, DOTmed News Online Editor | May 19, 2014
In an effort to reduce unnecessary care and waste in the health care system, researchers from Harvard Medical School Department of Health Care Policy went after certain tests and procedures that Medicare beneficiaries receive which, according to empirical studies, have been shown to offer little or no health benefit.

They found that at least one in four Medicare recipients received one or more of these "low-value" services in 2009, resulting in at least $1.9 billion in Medicare spending for that year alone.

The study was published in JAMA Internal Medicine.

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The research team defined 26 Medicare claims-based measures of low-value services, which included cervical cancer screening for women 65 years and older, CT scanning of the sinuses for uncomplicated acute rhinosinusitis (inflammation of the sinuses), preoperative stress testing and back imaging for patients with low back pain. Then they analyzed 2009 claims from more than 1.3 million Medicare beneficiaries who used the 26 services and assessed the proportion of beneficiaries receiving these services, average per-beneficiary service use, and the proportion of total spending connected with these services.

"Even just looking at a fraction of wasteful services and using our narrowest definitions of waste, we found that one quarter of Medicare beneficiaries undergo procedures or tests that don't tend to help them get better," said Aaron Schwartz, a Ph.D. student in the HMS Department of Health Care Policy, and lead author of the study.

He said waste was especially hard to define in the context of this study, however, since it can depend on how you define it and "removed from the clinical details of a particular patient, it is hard to know whether a given procedure might be useful or not."

For example, lower back imaging for general back pain offers little benefit to patients with muscle soreness, but it can be lifesaving when used to identify cancer or spinal abscess.

The Medical Imaging & Technology Alliance (MITA), an industry lobby, responded to the study saying that there are better methods to guide use of imaging exams.

"A thoughtful, evidence-based approach, rooted in AUC [appropriate use criteria], is the best way to safeguard access and guide medical imaging utilization in a way that is tailored to each patient's unique medical condition," said Gail Rodriguez, executive director of MITA.

Although the authors admit that it's hard to measure a low-value service well with claims data, it could help track overuse and evaluate programs to reduce it.

In an editor's note, JAMA Internal Medicine deputy editor Dr. Mitchell H. Katz and colleagues wrote: "...We hope that development of better measures of low-value care will ultimately spur development of interventions to reduce unnecessary care."

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