Tuesday, April 28, 2015

Cost an indirect measure of waste, Medicare researcher says

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DALLAS – A growing body of health care research shows significant waste can be found by looking at the overuse of certain medical services.

"Cost is an indirect measure of overuse," said Dr. Aaron Schwartz, a doctoral candidate at Harvard Medical School, who co-authored a recent report on Medicare waste published in The Journal of the American Medical Association.

"Our study was an attempt to look at services directly that have been overused," he said.

Schwartz and co-authors tracked the use of 26 provider-billed services under Medicare Part B. Those services, such as cervical cancer screenings for women over 65 and over-frequent bone density tests, have been previously identified in medical literature as "low value," which provide no real benefit to patients.

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  • They found that up to 42 percent of Medicare beneficiaries had received at least one such low-value service during the 2009 study period. Those unnecessary procedures accounted for as much as $8.5 billion in Medicare spending, or about $310 per beneficiary spent on just those services identified by the researchers.

    "We're saying it's the tip of the iceberg," said Schwartz.

    Other studies have also found systemic problems related to the overuse of medical services under Medicare's fee-for-service payment structure.

    A 2013 study also published in JAMA found significant differences in service use between patients enrolled in the traditional Medicare Part B fee-for-service program and those enrolled in the Medicare Advantage program, which caps benefits at a certain level.

    Patients enrolled in Medicare Advantage were prescribed significantly fewer cardiac procedures than those enrolled in traditional Medicare, researchers found. They said that suggested payment structure may have contributed to additional procedures for patients beyond their medical needs.

    The study also showed that the influence the type of payment system has on use rates is inextricably linked to the local culture of practitioners, according to Daniel Matlock, who co-authored the study.

    "You can change the payment structure all day long; you still need to get into the local culture," Matlock said.

    He noted the case of McAllen, which has one of the highest across-the-board Medicare expense rates in the nation. Researchers from the Dartmouth Institute for Health Policy & Clinical Practice studied McAllen several years ago and attributed those high costs in large part to the "local culture of medical practice." A 2009 New Yorker article about the institute's findings called it a "culture of money."

    Experts say cultural influence, in studies like Matlock's and the institute's, points to discretionary patterns in doctors' behavior rather than issues specific to patients' health as affecting costs.

    "It goes against the argument that doctors make that people in our area are sicker," said Matlock. "Well, not in our data."

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