Medicare Pays Billions for Wasteful Care
Two key findings from the report involve regionalization of low-value care.
The first, Schwartz says, is that regionally, providers seem to be somewhat consistent in how much low-value care they deliver to Medicare beneficiaries. "Groups of providers who tend to provide high levels of one type of low-value service also tend to supply high levels of other types of low-value services," he says.
The second is that the difference between regions that spent the least—less than 95% of everyone else—spent $227 per beneficiary, which was not that much lower than the regions that were spending the most, $416 per beneficiary. "We saw a lot of dollars even in that low-spending group, indicating a substantial amount of overuse even in the regions with the lowest amount of overuse."
Developing a measure to define overuse was extremely difficult for the researchers because the federal claims database does not contain the reasons why patients were told to undergo the low-value services. For example, an incorrectly or poorly coded Medicare claim for a screening test might not accurately identify a patient as a high risk candidate for repeated follow-up screenings, Schwartz explains.
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