Medicare could save $3.6 billion without risk to older adults, study suggests

Medicare is a federal government program that provides healthcare coverage for older adults in the United States. A recent study has found that Medicare and older adults together spend $4.4 billion annually on care that has low clinical value and can even pose risks to patients.

The study identified 47 tests, scans, and procedures that do not benefit most patients and may even harm them. By reducing the use of these low-value services, Medicare could allocate funds for more essential care. In particular, focusing on just five of these services could save $2.6 billion in Medicare spending. These services have received a grade of “D” from the U.S. Preventive Services Task Force due to their ineffectiveness or potential risks outweighing benefits.

The five low-value services include screening for chronic obstructive pulmonary disease, testing for bacteria in urine without symptoms, prostate-specific antigen testing in men over 70 without a history of prostate issues, and screening for carotid artery blockage or heart rhythm issues in asymptomatic older adults.

The study also identified 42 additional services deemed low-value for some or all patients by medical professional societies. Seventeen of these services, along with the five grade D services, accounted for 94% of the low-value care identified in the study.

Health economist David D. Kim and primary care physician A. Mark Fendrick conducted the study to address the need to reduce waste and control costs in Medicare. Their findings, published in JAMA Health Forum, emphasize the importance of evidence-based clinical decisions to determine which services are beneficial for patients.

The researchers analyzed Medicare data from 2018 to 2020 to identify unnecessary medical spending and quantify potential savings by avoiding low-value services. They stress the need for a patient-focused approach to healthcare to ensure that resources are allocated effectively.

The study highlights the importance of value-based insurance design in healthcare policies, such as the ACA provision that allows Medicare to withhold payment for low-value preventive services. By prioritizing high-value care and reducing unnecessary spending, Medicare could save billions of dollars without compromising patient outcomes.

For more information on the study and a full list of low-value services analyzed, refer to the JAMA Health Forum publication. The research underscores the significance of evidence-based decision-making in healthcare to optimize resources and improve patient care.