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Primary Care Physicians 'Generally' Good Gatekeepers for Low-Value Services, Study Finds

Analysis  |  By Christopher Cheney  
   January 19, 2021

The researchers reviewed utilization of low-value services such as imaging for non-specific back pain and arthroscopic surgery for knee osteoarthritis.

Most primary care physicians are effective at limiting the ordering of low-value medical services, a new research article says.

Earlier research found that annual spending on low-value medical services in U.S. healthcare ranges from $75 billion to $100 billion. "Primary care physicians (PCPs) have been conceptualized as potential gatekeepers for efforts to reduce low-value spending," the co-authors of the new research article wrote.

The new research article, which was published this week in Annals of Internal Medicine, analyzed Medicare Part B claims from a random sample of beneficiaries enrolled between 2007 and 2014. Examples of low-value medical services included imaging for non-specific back pain, prostate specific antigen screening for men older than 75, and arthroscopic surgery for knee osteoarthritis.

The study includes two key data points:

  • For most PCPs, the medical services they performed or ordered accounted for less than 9% of their patients' low-value spending, which represented less than 0.3% of their total Medicare Part B spending.
     
  • For most PCPs, referrals accounted for less than 16% of their patients' low-value spending, which represented less than 0.5% of their total Medicare Part B spending.

The data indicates PCPs are effective gatekeepers for low-value medical services, the lead author of the study told HealthLeaders.

"Our findings suggest that PCPs generally do a good job avoiding performing, ordering, or referring their patients for low-value services. For most PCPs, spending from low-value services they performed or ordered accounted for less than 9% of their panel's total low-value spending, and services they referred their patients out for accounted for less than 16% of their panel's total low-value spending," said Aaron Baum, PhD, assistant professor, Department of Health System Design & Global Health, Icahn School of Medicine at Mount Sinai Health System, New York, New York.

Spending on low-value medical services accounts for a significant amount of wasteful healthcare spending, he said. "One trillion dollars—25%—of healthcare spending is classified as waste. Of this, low-value services, which can be measured using claims data, account for upto $100 billion per year. We need to be able to measure more of the remaining $900 billion of wasted spending using readily available data sources in order to monitor and better understand the sources of wasted healthcare spending overall."

The specialties that contributed the most to low-value spending included cardiology, ambulatory surgical centers, internal medicine, orthopedic surgery, and gastroenterology, Baum said.

Related: Wasteful Spending in U.S. Healthcare Estimated at $760 Billion to $935 Billion

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

For most PCPs, the medical services they performed or ordered accounted for less than 9% of their patients' low-value spending, which represented less than 0.3% of their total Medicare Part B spending.

For most PCPs, referrals accounted for less than 16% of their patients' low-value spending, which represented less than 0.5% of their total Medicare Part B spending.


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