Inappropriate outpatient care and health care costs on ‘top five’ list

Kale M. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.501.

Issue: November 2011

There is considerable variability in the frequency of inappropriate care in outpatient visits, with many activities identified as having marginal effect on health care costs, researchers wrote in a recent study.

In this cross-sectional analysis, researchers used data from the 2009 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to determine the frequency and associated costs of the top five overused activities in pediatrics, internal medicine and family medicine presented by the Good Stewardship Working Group. The sample was limited to patient visits to their primary care physician, and each of the top five primary care activities were identified through patient-described reason for visit and physician’s diagnosis.

Each activity was calculated “as the proportion of eligible visits during which the patient received nonrecommended care,” according to researchers. Costs of the procedures were measured using the 2011 Medicare physician fee schedule and, when laboratory tests were used, the 2011 Medicare Clinical Laboratory Fee Schedule.

Overall, researchers found a wide range of frequencies of nonrecommended activities in primary care, accounting for an approximate annual cost of $6.76 billion (95% CI, 5-9.1), but the most prevalent activity was ordering of complete blood cell count for a general medical examination (56%; 95% CI, 40.8-70.2) with an overall associated cost of $32.7 million (95% CI, 23.9-40.8). Prescribing brand instead of generic statins (95% CI, $4.3 billion-$7.3 billion) and bone density testing in women younger than 65 years (95% CI, $474 million-$1.054 billion) were associated with the highest cost, but bone density testing in women younger than 65 years (1.4%; 95% CI, 0.9-2.2) and Papanicolaou tests for patients younger than 21 years (2.9%; 95% CI, 1.7-5) were two activities that researchers found occurred less commonly.

“Approximately 86% of the costs associated with the ‘Top 5’ lists were from the use of brand name instead of generic statins,” researchers wrote. “Although generic drug substitutions may appear to be a “low hanging fruit” for drug savings, numerous efforts have already been made by the US states (generic substitute laws), payers (tiered formularies), and health care providers (generic drug detailing) to achieve this goal. In this light, our data suggest that considerably more work is needed to reduce the costs associated with brand name statin use.”

Disclosure: There were no financial disclosures reported with this study.

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