CMS spent upward of $6.5 billion on low-value healthcare services in a single year, with cancer screenings and imaging accounting for a large portion of the total.
That’s according to a July 26 report from the Medicare Payment Advisory Commission. The report shows physicians and other providers delivered between 34 and 70 low-value services per 100 fee-for-service Medicare beneficiaries in 2021, with Medicare paying $2.2 billion for them on the lower end of its estimate range.
“Imaging for nonspecific low back pain” was listed as the No. 1 most frequently occurring low-value service, impacting between 3.4% and 9.3% of beneficiaries. That resulted in a total of between $77 million and $262 million in spending on a healthcare service that provides little to no benefit to the patient while introducing a source of potential harm.
“The spending estimates probably understate actual spending on low-value care because they do not include the cost of downstream services (e.g., follow-up tests and procedures) that may result from the initial low-value service,” the report’s authors noted.
MedPAC also cautioned that it may not have captured all low-value care through the 31 measures, which were compiled by a team of researchers. Experts pulled the list from evidence-based guidance provided by the Choosing Wisely campaign and other medical literature, applying the measures to 100% of Medicare claims from a single year. They also developed both a narrower, more specific measure and a broader, more sensitive version of the equation, with the latter likely to capture more inappropriate use but also improperly classify some services as medically unnecessary.
Imaging and cancer screening accounted for about 58% of the total volume of low-value treatments, or from $1.3 billion to nearly $3.8 billion. The cancer screening category incorporates services not provided by the specialty, such as prostate-specific antigen testing among individuals older than 75. Other radiology services on the list included preoperative chest X-rays (impacting 0.4%-3.5% of beneficiaries and totaling $12 million to $53 million), head imaging for uncomplicated headache (1.8%-2.9%, $135 million to $221 million), and CT for uncomplicated sinus infections (0.2%-0.5%, $18 million to $38 million).
You can find the full data book from MedPAC, titled “Health Care Spending and the Medicare Program,” here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.