Potential Medicare Savings of $3.6 Billion by Reducing Low-Value Services, Study Finds

A recent study reveals that the U.S. Medicare program, in conjunction with older adults, allocates approximately $4.4 billion annually to healthcare services that offer limited or no clinical benefit and may even pose risks. Researchers analyzed 47 common tests, scans, and procedures, many of which research has shown to be ineffective for most patients. By cutting down on these unnecessary services, Medicare could redirect funds towards more impactful healthcare interventions.

Focusing specifically on just five of these services with a grade of 'D' from the U.S. Preventive Services Task Force—indicating they are ineffective or potentially harmful—could save Medicare and its beneficiaries around $2.6 billion each year. These services include screening older adults for chronic obstructive pulmonary disease (COPD), urine bacterial infections in asymptomatic individuals, prostate-specific antigen testing in men over 70 without risk factors, and screenings for carotid artery blockage and heart rhythm irregularities in asymptomatic older adults. The 'D' grade empowers the Secretary of Health and Human Services to withhold payments under the Affordable Care Act for these services.

The study, conducted by health economist David D. Kim, Ph.D., and primary care physician A. Mark Fendrick, M.D., emphasizes the importance of a nuanced, patient-centered approach to reducing healthcare waste. They utilized anonymous Medicare billing data from 2018 to 2020 to project savings nationwide, highlighting the potential for policy actions that target low-value care without compromising necessary treatments.

Beyond these top five services, the research identified 42 additional low-value procedures, many of which are supported by professional societies and research. Notably, 17 of these, including three of the grade 'D' services, accounted for 94% of the low-value care spending. The authors advocate for evidence-based, targeted policy reforms aligned with value-based insurance design, which could significantly optimize Medicare spending and improve patient safety.

This research underscores that substantial savings are achievable by eliminating unnecessary testing and interventions, particularly in populations unlikely to benefit, thereby enhancing overall healthcare efficiency while safeguarding patient well-being.

Source: MedicalXpress