Medicare Spent $8.5B on Unnecessary Procedures in 2009, Study Says
As many as 42% of Medicare beneficiaries underwent unnecessary medical procedures in 2009, costing the federal government as much as $8.5 billion, according to a study published online Monday in JAMA Internal Medicine, Reuters reports.
The analysis is the first large-scale look into what Medicare spends on procedures that are widely considered to be unnecessary, such as advanced imaging for lower back pain and placing stents in patients with controlled heart disease (Begley, Reuters, 5/12).
For the study, researchers examined Medicare claims for 1.3 million beneficiaries in 2009 and compared them against a list of 26 "low-value" procedures. They compiled the list of procedures they believed reflect overuse from research evidence and suggestions from various medical groups (AP/Miami Herald, 5/12).
Researchers found that a minimum of one in four Medicare patients were subjected to unnecessary procedures in 2009 (Reuters, 5/12). In total, the researchers identified 21.9 million instances of using the low-value services (Rau, "Capsules," Kaiser Health News, 5/12). The percentage of spending that went to the low-value services overall in Medicare Parts A and B ranged between 0.6% and 2.7%, the study noted.
Further, since the list of 26 low-value services likely did not include all unnecessary procedures, the authors noted that actual spending on low-value services likely is far larger (Gever, "The Gupta Guide," MedPage Today, 5/12). In addition, since the study only focused on one year, the authors suggested it is likely the practice and wasteful spending has continued (Reuters, 5/12).
However, the authors noted that it is difficult to determine exactly how many instances of using the low-value services were actually unnecessary, since one procedure might provide no benefit to most patients and some benefit to others. Still, the authors found that even if many of the patients did benefit from the services, about 9.1 million instances of unnecessary procedures occurred in 2009. In such a case, 25% of Medicare beneficiaries would have undergone an unnecessary procedure and the program would have wasted $1.9 billion, or 0.6% of its overall spending ("Capsules," Kaiser Health News, 5/12).
According to the study, it is unclear why providers are ordering the unnecessary procedures, but some possibilities include:
- Patient demand for services they incorrectly think will help;
- Providers being paid more for ordering more procedures; and
- Fear of malpractice lawsuits (AP/Miami Herald, 5/12).
The study authors noted that in addition to financial costs, the low-value services could have adverse effects on patient health by exposing them to unnecessary radiation and surgery (Reuters, 5/12).
However, since it is difficult to determine which procedures are unnecessary in specific patient cases, it is also difficult to try to monitor whether specific treatments are appropriate overall.
In order to circumvent this issue, the authors recommended paying providers in bundled payments instead of based on the number or procedures they order or complete ("Capsules," Kaiser Health News, 5/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.