Trends in Use of Low-Value Care in Traditional Fee-for-Service Medicare and Medicare Advantage

Park, Sungchul; Jung, Jeah; Burke, Robert E.; Larson, Eric B.

doi:10.1001/jamanetworkopen.2021.1762

Cited by 35 publications

(43 citation statements)

References 38 publications

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“…17 We previously created an Overuse Index that uses billing codes for diverse clinical services that act as indicators to reflect the latent tendency of a region to overuse health care resources relative to other regions. [18][19][20][21] Conceptually, the Overuse Index should function like the Consumer Price Index, which uses the average price of a "market-basket" of goods and services to track inflation. In the present work, we have updated the Overuse Index to use International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes and have adapted it to describe low-value care at the level of health care systems in the United States.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Overuse of Health Care Within US Health Systems

et al. 2022

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IMPORTANCEOveruse of health care is a pervasive threat to patients that requires measurement to inform the development of interventions. OBJECTIVE To measure low-value health care use within health systems in the US and explore features of the health systems associated with low-value care delivery. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional analysis, we identified occurrences of 17 low-value services in 3745 hospitals and affiliated outpatient sites. Hospitals were linked to 676 health systems in the US using the Agency for Healthcare Research and Quality (AHRQ) Compendium of Health Systems. The participants were 100% of Medicare beneficiaries with claims from 2016 to 2018. EXPOSURES We identified occurrences of 17 low-value services in 3839 hospitals and affiliated outpatient sites. MAIN OUTCOMES AND MEASURES Hospitals were linked to health systems using AHRQ'sCompendium of Health Systems. Between March and August 2021, we modeled overuse occurrences with a negative binomial regression model including the year-quarter, procedure indicator, and a health system indicator. The model included random effects for hospital and beneficiary age, sex, and comorbidity count specific to each indicator, hospital, and quarter. The beta coefficients associated with the health system term, normalized, reflect the tendency of that system to use low-value services relative to all other systems. With ordinary least squares regression, we explored health system characteristics associated with the Overuse Index (OI), expressed as a standard deviation where the mean across all health systems is 0. RESULTS There were 676 unique health systems assessed in our study that included from 1 to 163 hospitals (median of 2). The mean age of eligible beneficiaries was 75.5 years and 76% were women.Relative to the lowest tertile, health systems in the upper tertile of medical groups count and bed count had an OI that was higher by 0.38 standard deviations (SD) and 0.44 SD, respectively. Health systems that were primarily investor owned had an OI that was 0.56 SD higher than those that were not investor owned. Relative to the lowest tertile, health systems in the upper tertile of primary care physicians, upper tertile of teaching intensity, and upper quartile of uncompensated care had an OI that was lower by 0.59 SD, 0.45 SD, and 0.47 SD, respectively. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of US health systems, higher amounts of overuse among health systems were associated with investor ownership and fewer primary care physicians. The OI is a valuable tool for identifying potentially modifiable drivers of overuse and is adaptable to other levels of investigation, such as the state or region, which might be affected by local policies affecting payment or system consolidation.

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Section: Introductionmentioning

confidence: 99%

Factors Associated With Overuse of Health Care Within US Health Systems

et al. 2022

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“… 14 As a sensitivity analysis, we conducted the analysis described earlier after applying inverse probability of treatment weights. 15 Specifically, we computed the inverse probability of treatment weights as a propensity for enrolling in MA according to the variables described.…”

Section: Methodsmentioning

confidence: 99%

Association of Health Insurance Literacy With Enrollment in Traditional Medicare, Medicare Advantage, and Plan Characteristics Within Medicare Advantage

2022

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IMPORTANCE Health insurance literacy helps individuals make informed choices. However, evidence suggests that Medicare beneficiaries experience low health insurance literacy, leading to high-cost or poor-quality coverage choices. OBJECTIVE To examine how health insurance literacy was associated with coverage choices between traditional Medicare (TM) and Medicare Advantage (MA), as well as within MA.

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“…Our findings have several implications for efforts to reduce low-value care. Within the TM program, in which low-value care has remained prevalent despite policy and research attention, 5,6 it may be possible to leverage elements of insurance design to encourage the deadoption of low-value services. One opportunity is to expand the penetration of value-based payment models, an approach consistent with the strategy recently articulated by the Center for Medicare and Medicaid Innovation.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries

Boudreau

Schwartz

et al. 2022

JAMA Health Forum

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IMPORTANCE Low-value care in the Medicare program is prevalent, costly, potentially harmful, and persistent. Although Medicare Advantage (MA) plans can use managed care strategies not available in traditional Medicare (TM), it is not clear whether this flexibility is associated with lower rates of low-value care. OBJECTIVES To compare rates of low-value services between MA and TM beneficiaries and explore how elements of insurance design present in MA are associated with the delivery of low-value care. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed beneficiaries enrolled in MA and TM using claims data from a large, national MA insurer and a random 5% sample of TM

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Trends in Use of Low-Value Care in Traditional Fee-for-Service Medicare and Medicare Advantage

Abstract: This cross-sectional study compares use of low-value care among individuals enrolled in traditional Medicare and those enrolled in Medicare Advantage and examines trends in use from 2006 to 2015.

Cited by 35 publications

References 38 publications

Factors Associated With Overuse of Health Care Within US Health Systems

Factors Associated With Overuse of Health Care Within US Health Systems

Association of Health Insurance Literacy With Enrollment in Traditional Medicare, Medicare Advantage, and Plan Characteristics Within Medicare Advantage

Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries

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