Surgical Low-Value Care Between Fee-For-Service and Salaried Health Care Systems

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Economics

Background:

• Low-value care, including unnecessary surgeries, increases healthcare costs and compromises patient outcomes.
• The reimbursement model, such as fee-for-service versus salaried, may influence the utilization of low-value surgical procedures.

Purpose of the Study:

• To investigate the association between healthcare reimbursement models (direct vs. private sector care) and the incidence of low-value elective surgeries.
• To compare rates of low-value surgery across different surgical procedures and timeframes.

Main Methods:

• A retrospective cohort study analyzing TRICARE health care claims from fiscal years 2016-2023.
• Included patients aged 10+ undergoing specific elective procedures: acromioplasty, partial knee meniscectomy, rotator cuff repair, wrist, or ankle arthroscopy.
• Multivariable logistic regression was used to adjust for case mix, comparing low-value care rates between direct and private sector settings.

Main Results:

• The study analyzed 304,908 procedures. Low-value surgery rates were 20% in direct care versus 35% in the private sector (P < .001).
• The private sector had significantly higher odds of low-value surgery (OR, 1.41; 95% CI, 1.38-1.45) after adjustment.
• Both sectors showed reduced low-value surgery rates in 2020-2023 compared to 2016-2019.

Conclusions:

• Direct care settings demonstrated a consistently lower likelihood of low-value surgery compared to the private sector.
• Findings suggest that transitioning clinician reimbursement from fee-for-service to salaried models is associated with reduced rates of low-value care.