Measuring Low Value Care in Medicare

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The Issue

While many quality improvement efforts focus on the underuse of health services, few have sought to assess the overuse of medical care. To control health care spending, reliable methods are needed to identify services that provide little or no health benefit to patients. This JAMA Internal Medicine study, coauthored by Adam Elshaug, a 2010–11 Harkness Fellow in Health Care Policy and Practice and former Commonwealth Fund Visiting Fellow, tested ways to detect the delivery of “low value” care, using 2009 Medicare claims data for a national sample of nearly 1.4 million beneficiaries.


What the Study Found

Researchers developed 26 measures to assess the extent to which low-value services—ranging from certain types of cancer screenings and medical imaging to surgical procedures—are provided to Medicare beneficiaries. To compare the effectiveness of different measurement approaches, they created two measure types: one more likely to capture inappropriate use of services (i.e., more sensitive), and one less likely to classify appropriate use as inappropriate (i.e., more specific). Using the more sensitive measures, the researchers found that 42 percent of beneficiaries received low-value care, accounting for 2.7 percent of overall annual spending on services covered by Medicare Parts A and B. Using the more specific measures, 25 percent of beneficiaries were found to have received low-value care, contributing 0.6 percent of annual spending.


Conclusions

Even though the low-value care measured in this study accounted for only modest proportions of overall Medicare spending, it affected large numbers of beneficiaries. Moreover, it may be an indication of more widespread trends. The use of health care claims data to identify low-value care may be useful for tracking health care overuse and evaluating the effects of programs designed to reduce it.

Publication Details

Publication Date:
July 15, 2014
Authors:
Aaron L. Schwartz, Bruce E. Landon, Adam Elshaug , Michael Chernew, J. Michael McWilliams
Contact:
J. Michael McWilliams, Associate Professor, Department of Health Care Policy, Harvard Medical School
E-mail: mcwilliams@hcp.med.harvard.edu
Summary Writer:
Martha Hostetter
Citation:
A. L. Schwartz, B. E. Landon, A. G. Elshaug et al., “Measuring Low-Value Care in Medicare,” JAMA Internal Medicine, July 2014 174(7):1067–76.
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