CMS should consider cutting pay for low-value imaging to curb misuse, RAND Corp. says
Medicare recipients continue to receive low-value imaging services, despite efforts to curb misuse, and the trust fund should consider cutting pay to find further gains.
That’s according to a new RAND Corp. analysis of 2014-2018 fee-for-service claims data, published Tuesday in JAMA Network Open. Tracking 32 different unnecessary care practices—such as imaging for an uncomplicated headache or CT of the head tied to sudden hearing loss—experts found related spending only dropped modestly.
All told, the proportion study subjects who received low-value care declined from 36.3% in 2014 down to 33.6% a few years later. Annual spending per 1,000 individuals, meanwhile, fell from $52,766 to $46,922, a small dip that occurred despite national campaigns and payment revisions to address wasteful care, authors noted.
“While educational efforts, such as the Choosing Wisely campaign, are important for raising awareness of the problem among clinicians and patients, additional efforts will be needed to significantly curb low-value care use and spending in light of our findings,” lead author John Mafi, MD, a RAND policy researcher and UCLA professor of medicine, and colleagues wrote Feb. 16. “Specifically, we found that increases in the price of services, such as certain diagnostic imaging tests and invasive procedures, were also associated with increases in low-value care spending, and addressing price increases may represent an important strategy in reducing wasteful spending,” the team added, citing interventional radiologist-inserted PICC lines as one example.
To reach their conclusions, Mafi et al. utilized the Milliman MedInsight Health Waste Calculator to assess claims for different low-value services. The software deems care as likely, not at all, or for-sure wasteful based on Choosing Wisely and other guidelines, with no indicated use for the service in claims history.
“For example, to determine whether imaging for headache was low value for an individual, we required at least 12 months of historical claims data for that individual to ensure that no cancer or head trauma diagnosis had been made in the previous year that would make use of imaging not wasteful,” the authors wrote.
Other imaging-related services in the analysis included brain scans for simple syncope with normal neurological symptoms, emergency CT for the evaluation of dizziness, and coronary artery calcium scoring for known CAD. Mafi and co-authors included more than 21 million fee-for-service Medicare beneficiaries in the final analysis. Three nonradiology services accounted for about two-thirds of low-value care in the study: preoperative lab testing, opioids for back pain, and antibiotics for upper respiratory infections.
The researchers called for further interventions to address such wasteful care, including action from policymakers, additional payment reform, education campaigns targeted at patients and physicians, and clinical decision support tools.
“Given mushrooming deficits and the fact that the Medicare trust fund is running out of cash, there will be enormous pressure to find ways to trim spending in the Medicare program and making significant progress in reducing low value care needs to be a top priority," Mafi said in a statement.
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.