Nearly $500 million a year in Medicare costs goes to 7 services with no net health benefits


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Under the Affordable Care Act, the secretary of health and human services is authorized to prohibit payment for services given a “D” rating by the U.S. Preventive Services Task Force, the researchers say.

FINDINGS

A UCLA-led study shows that physicians frequently order preventive medical services for adult Medicare beneficiaries that are considered unnecessary and of “low value” by the U.S. Preventive Services Task Force — at a cost of $478 million per year.

The researchers analyzed national survey data over a 10-year period, looking specifically at seven preventive services given a “D” rating by the task force, and discovered that these services were ordered more than 31 million times annually.

BACKGROUND

The U.S. Preventive Services Task Force, an independent panel appointed by the Department of Health and Human Services, makes recommendations on the value of clinical preventive services. Services rated D are considered to have no likely health benefit to specific patients and may even be harmful to them. Overall, the utilization of a variety of services considered unnecessary by the task force drives up health care spending by billions of dollars each year.

METHOD

The researchers examined data covering the years 2007 to 2016 from the annual National Ambulatory Medical Care Survey to determine how often, and at what cost, seven specific grade D services were utilized:

  • Asymptomatic bacteriuria screening in non-pregnant women
  • Cardiovascular disease screening in low-risk adults (rest or stress ECG)
  • Cervical cancer screening in women over age 65 (Papanicolaou or HPV test)
  • Colorectal cancer screening in those over age 85 (colonoscopy or sigmoidoscopy)
  • Chronic obstructive pulmonary disease screening in asymptomatic patients (peak flow or spirometry)
  • Prostate cancer screening in men 75 and older (prostate-specific antigen test)
  • Vitamin D supplementation for fracture preventing in postmenopausal women

The researchers note some limitations to the study. For instance, their method of estimating Medicare spending on these services may lack clinical details and therefore might misclassify some instances of appropriate care as low value.

IMPACT

Medicare could save nearly $500 million per year and protect patients against potential harm by no longer providing reimbursements for these services. Under the Affordable Care Act, the secretary of health and human services is authorized to prohibit payment for services rated D by the Preventive Services Task Force. In February 2021, the U.S. Office of Personnel Management’s Federal Employees Health Benefits Program stopped covering (PDF) grade D services.

AUTHORS

Dr. Carlos Irwin Oronce, Dr. Joseph Ladapo, Dr. Catherine Sarkisian and Dr. John Mafi, all of UCLA, and Dr. A. Mark Fendrick of the University of Michigan. Dr. Mafi is also a researcher with Rand Corp.

JOURNAL

The study is published in the peer-reviewed Journal of General Internal Medicine.

FUNDING

The study was funded by the Veterans Affairs Office of Academic Affiliations (through the VA/National Clinician Scholars Program); the National Institute on Drug Abuse; the National Heart, Lung, and Blood Institute; the National Institute on Minority Health and Health Disparities; the National Institute on Aging, the UCLA Resource Center for Minority Aging Research/Center for Health Improvement of Minority Elders; the National Center for Advancing Translational Science; the UCLA Clinical and Translational Science Institute; the UCLA Vatche and Tamar Manoukian Division of Digestive Diseases; and the National Institute on Aging’s Beeson Emerging Leaders career development award funded this study.

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