PCPs perform small percentage of low-value services
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Most primary care physicians performed, ordered and referred out a minority of their patients’ spending on low-value services, a retrospective study in Annals of Internal Medicine showed.
“Because primary care physicians are central to value-based payment and delivery reform efforts, we were interested in studying how relevant current low-value care indicators are to most primary care physicians and in identifying actions that primary care physicians can take or change to meaningfully reduce wasted health care spending,” Aaron Baum, PhD, an assistant professor of global health at Icahn School of Medicine at Mount Sinai, told Healio Primary Care.
Baum and colleagues analyzed Medicare Part B claims from 8,402,085 randomly chosen beneficiaries enrolled between 2007 and 2014. The beneficiaries were continuously enrolled in fee-for-service Medicare Parts A and B in a given year and previous year. They had a mean age of 73 years, 57% were women and 83.7% were white.
The researchers attributed the beneficiaries to 210,277 PCPs. They reported that 60.9%, 21.3%, 9.4% and 8.4% of beneficiaries received 0, 1, 2 and 3 or more low-value services, respectively. Annual spending on low-value Part B services ($171.33) equaled 4.2% of total Part B spending ($4,063.49) and 1.4% of total Medicare spending ($11,991.99) for each beneficiary.
Among PCPs with at least 20 attributed beneficiaries in the study sample, services that they performed or ordered comprised a median of 8.3% (interquartile range [IQR] = 3.9-15.1, 95th percentile) of patients’ overall spending on low-value services. The services PCPs referred out comprised a median of 15.4% (IQR = 6.3-26.4, 95th percentile) of such spending. These services made up 0.3% and 0.5%, respectively, of the median total Medicare Part B spending of PCPs’ patient panels. Cardiology was the largest share of low-value spending (27.3%), followed by primary care (14.5%), ambulatory surgical centers (8.9%), internal medicine (7%), orthopedic surgery (4.9%) and gastroenterology (4.8%).
Baum said that previous studies have shown low-value care spending varies widely across PCPs.
“PCPs seeking to manage their panels’ total cost of care by reducing overuse of low-value services should consider using referral support tools that can help their patients avoid expensive low-value services delivered by other providers,” he added.
The researchers concluded that future studies should find ways to “minimize low-value measurement burden in primary care.” They also said more studies are needed to analyze practice patterns among PCPs who are “responsible for a major share of their patients’ low-value spending,” as well as referral tools and payment strategies that spur management of low-value care beyond primary care services.