Measuring low-value care in Medicare.

Area of Science:

• Health Services Research
• Health Economics
• Medical Informatics

Background:

• Identifying and reducing wasteful health care use is crucial.
• Direct measures of overuse are needed to target specific services.
• Low-value care can be characterized even among efficient providers.

Purpose of the Study:

• Develop claims-based measures for low-value health care services.
• Analyze the utilization and spending of these services in Medicare.
• Investigate correlations in the patterns of using different low-value services.

Main Methods:

• Created 26 claims-based measures from evidence-based lists of services with minimal benefit.
• Analyzed 2009 Medicare claims data for over 1.3 million beneficiaries.
• Assessed service use, spending, and correlations across 6 categories of low-value services.

Main Results:

• Sensitive measures identified low-value services used by 42% of beneficiaries, accounting for 2.7% of spending.
• Specific measures identified services used by 25% of beneficiaries, accounting for 0.6% of spending.
• Regional low-value spending varied significantly, and use of different low-value services was often correlated.

Conclusions:

• Claims-based measures can identify substantial low-value care affecting many Medicare beneficiaries.
• While constituting a modest proportion of total spending, this care may reflect broader overuse.
• The effectiveness of these measures for policy depends on their precise definition.