Medicare Spends Billions On Wasteful Medical Procedures
By Christine Kern, contributing writer
A JAMA study concludes wasteful services cost Medicare up to $8.5 billion.
By Christine Kern, contributing writer
A study published in JAMA Internal Medicine shows as many as 42 percent of U.S. Medicare patients were subjected to procedures providing little if any medical benefit, costing the government program up to $8.5 billion – 2.7 percent of the program's overall spending – in unnecessary payments. It is the first large-scale analysis of what Medicare spends on unnecessary procedures such as advanced imaging for simple lower back pain or inserting stents in patients with stable heart disease.
The study suggests one in four Medicare patients got medical care at least once in 2009 that provided no benefit at a total cost of at least $1.9 billion.
The researchers took a two-step approach. First, they analyzed Medicare billing records to isolate services provided to patients where they might not be warranted. For example, when tallying the number of surgeries to remove plaque from a carotid artery in the neck, they focused on patients who did not have any history of symptoms of mini-strokes.
To err on the side of caution, the researchers then analyzed the records a second time, using the most restrictive definitions they could devise. With the more selective filter, the amount Medicare potentially wasted on that surgery dropped from $263 million to $110 million.
The results also indicate overuse varied by region. Across six categories – cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and other surgery – researchers found all categories of unnecessary medical care climbed or fell by region, except cardiovascular testing and procedures, where the study found no regional correlation.
The study highlights the opportunity for savings through efforts to eliminate medical care that has been identified by previous research as unnecessary and wasteful, such as colorectal screening among those 85 and older with no history of colon cancer.
As Modern Healthcare reports, the latest findings reflect just a fraction of potential overuse and the study's 26 measures are only an initial step toward more direct metrics that can be widely used by policymakers, health insurers, and others. “We won't fix the healthcare system by getting rid of just these 26 services,” said Aaron Schwartz, a student in the Harvard University School of Medicine, who co-authored the paper with Harvard University health policy professors Dr. Bruce Landon, Michael Chernew, and Dr. J. Michael McWilliams and Adam Elshaug of the University of Sidney.
The study also highlights the challenges in identifying useful measures. “Services detected by a limited number of measures of low-value care constituted modest proportions of overall spending but affected substantial proportions of beneficiaries and may be reflective of overuse more broadly. Performance of claims-based measures in supporting targeted payment or coverage policies to reduce overuse may depend heavily on how the measures are defined.”