Medicare, the federal government’s healthcare program for older adults, is spending $4.4 billion a year on care that has low clinical value and may even harm patients, according to a recent study. The study identified 47 tests, scans, and procedures that do not benefit most patients and recommended reducing their use to preserve Medicare funding for more important care.
Focusing on just five of these low-value services could save $2.6 billion in Medicare spending. These five services, which have received a grade of “D” from the U.S. Preventive Services Task Force, include screenings for chronic obstructive pulmonary disease, urine bacteria in asymptomatic patients, prostate-specific antigen testing in men over 70 without a history of prostate issues, and screening for carotid artery blockages and heart rhythm issues in asymptomatic older adults.
In addition to these five services, the study identified 42 other low-value services based on research studies and recommendations from medical professional societies. Seventeen of these services, along with three of the grade D services, accounted for 94% of the low-value care identified in the study.
The study, conducted by health economist David D. Kim, Ph.D., and primary care physician A. Mark Fendrick, M.D., highlights the importance of evidence-based clinical decisions to avoid unnecessary medical spending. By analyzing Medicare data from a random sample of people between 2018 and 2020, the researchers were able to estimate the potential savings from reducing low-value services across the entire Medicare population.
The findings of the study, published in JAMA Health Forum, emphasize the need for a patient-focused approach to healthcare spending to ensure that resources are allocated efficiently. By targeting low-value services that do not benefit patients, Medicare could save billions of dollars without compromising the quality of care.
The researchers advocate for value-based insurance design in healthcare policy, which involves removing coverage for low-value preventive services that have been deemed ineffective or harmful. By aligning reimbursement policies with clinical evidence, healthcare systems can prioritize high-value care and improve patient outcomes.
The full list of low-value services analyzed in the study, along with their rankings in total spending and utilization, is available for further reference. The study underscores the importance of evidence-based decision-making in healthcare policy to optimize resource allocation and improve the quality of care for older adults enrolled in Medicare.
