Medicare Pays Billions for Wasteful Care

Cheryl Clark, for HealthLeaders Media , May 14, 2014

Curbing Overuse
One approach to stem overuse, he says, is for federal and commercial insurance plan coverage policies to either require patients to pay high co-payments or deductibles for certain services. Or, he says, "maybe you set up pay-for-performance approaches where you're rewarding physicians on how they perform on certain metrics."

Accountable care organizations and bundled payment models set up by the Centers for Medicare & Medicaid Services and other payers "incentivize lower use of overused services, but maintain provider discretion and are less likely to have unintended consequences," Schwartz says.

By quantifying the extent to which patients receive some low-value procedures, the report takes the Choosing Wisely campaign one step further.

Choosing Wisely is an initiative of the American Board of Internal Medicine, which offers guidance to doctors, hospitals, and patients, on procedures of questionable value.

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2 comments on "Medicare Pays Billions for Wasteful Care"

@cascadia Sherry Reynolds (5/17/2014 at 2:36 PM)
Why in the world do we expect patients to have more information about which tests are needed than a doctor does? The average literacy rate in the US is 8th grade and medical literacy is the 5th grade. Even in the study the majority of the tests were in fact appropriate so we are going to ask seniors and the most vulnerable part of our population to suddenly question their doctors orders and or shift the cost of this service onto them? If doctors are unable to determine the appropriate use how can a patient get up to speed on when to order these tests? The over focus on a consumer model has very clear unintended consequences and in no other industrialized country is this the model they use to get better outcomes at lower costs.

Jeff (5/16/2014 at 4:03 PM)
Low value is in the eye of the beholder often times. Example: therapy digs for emotional support. Not very cost effective if you apply sane rules as have on these things like ct for headache in ER. But guess what, it provides relief of mental anxiety which is disease. Who is going to not order ct on headache when lawyers ready to sue for first one out of a thousand missed? Naive reporting....just like negative appendectomies... Supposed to let peopke get septic and die because cant have a neg appendectomy? Easy in retrospect to condemn doctors who order screening tests to alleviate suffering whether its mental or physical and to prevent lawsuits. Its not a doctoring problem. Its called risk/reward and cost benefit ratio. I can quit ordering all lab... Most of time its negative, so guess labs are low value. Broad studies like these are disgustingly intellectually naive.




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