Low-Value Services and Longitudinal Knowledge Assessment Performance

Low-value services (LVSs) remain common and account for a substantial amount of wasteful US health care spending.

To assess whether LVS use is associated with physicians' general clinical knowledge as measured by performance on the American Board of Internal Medicine's Longitudinal Knowledge Assessment (LKA).

This cross-sectional study included general internists enrolled in the LKA in 2022 or 2023 caring for Medicare fee-for-service beneficiaries aged 67 years or older in an outpatient setting during their first year of participation.

Physician first-year LKA scores.

Receiving any of 25 LVSs designed to measure low-value primary care. Patient level regressions were adjusted for patient demographics, comorbidities, physician practice characteristics, and patient location.

Of 898 365 included patients, 59% were female with a mean (SE) age of 76.8 (0.02) years, and 30% received at least 1 LVS. Of 7089 physicians, 3568 (50%) were male with a mean (SE) age of 52.5 (0.1) years. Having a physician with a top vs bottom quartile LKA score was associated with a logistic-regression adjusted 7.9% lower (95% CI, -10.5% to -5.3%, P < .001) chance of receiving any LVS during the year (bottom: 31.0% [95% CI, 30.4% to 31.7%]; top: 28.6% [95% CI, 28.1% to 29.1%]); absolute difference: -2.5 percentage points (95% CI, -3.3 to -1.6, P < .001). Significant differences were observed by LVS subtype including diagnostic or preventive testing (bottom: 10.4% [95% CI, 9.8% to 11.0%], top: 8.7% [95% CI, 8.3% to 9.1%]; absolute difference: -1.7 percentage points [95% CI, -2.5 to -0.9]; P < .001), cancer screening (bottom: 13.8% [95% CI, 13.4% to 14.3%], top: 12.3% [95% CI, 11.9% to 12.7%]; absolute difference: -1.5 [-2.1 to -0.9], P < .001), and imaging (bottom: 13.8% [95% CI, 13.4% to 14.2%]; top: 13.2% [95% CI, 12.9% to 13.5%]; absolute difference: -0.6 [95% CI, -1.1 to -0.1]; P = .02). LKA score quartile differences for individual LVSs were most prominent for total and free triiodothyronine testing in patients with hypothyroidism and prostate-specific antigen testing in males 75 aged years and older.

The findings of this cross-sectional study suggest patients cared for by physicians with higher first-year LKA scores were less likely to receive LVSs.