Medicare Pays Billions for Wasteful Care

Cheryl Clark, May 14, 2014

Developing a measure to define overuse was difficult, but researchers found a way to quantify 26 types of unnecessary medical procedures administered to Medicare beneficiaries and tallied the cost.

Two measures developed by Boston-area medical researchers to quantify the extent of needless care have been used to estimate that 25% to 42% of patients over age 65 received at least one low-value, potentially unnecessary healthcare service during the study period, and many received several.

The study examined just 26 types of procedures, such as stress testing for stable coronary disease, or CT imaging for patients with headache. Based on a sample of Medicare claims for 1.36 million beneficiaries in 2009, when extrapolated to all beneficiaries, the overuse of services unlikely to help represents between $1.9 billion and $8.5 billion in spending, or between $71 and $310 per patient for that year.

"Our bottom line is that our findings are consistent with the belief that overuse is extensive," says Aaron Schwartz, a medical student at Harvard Medical School's Department of Health Care Policy and lead author of the study. The report is published in the May 12th issue of JAMA Internal Medicine.

He emphasizes that "the overspending we find here is likely the tip of the iceberg, because we're only looking at such a narrow set of these 26 services, and we know there are hundreds more low-value services out there."

Schwartz says that the study is the first to quantify the extent to which Medicare beneficiaries receive a wide variety of unnecessary procedures. Prior studies have examined only one or two types of services, such as surgery for back pain.


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