published Monday, May 12th, 2014

Overtreating Medicare patients may costs billions

CHICAGO — A new study suggests that in a single year, up to 42 percent of Medicare patients got at least one medical procedure they didn't need — overtreatment that cost as much as $8 billion.

The treatments included prostate cancer screening for men beyond the age most experts recommend, and imaging tests in older women for osteoporosis at too frequent intervals. The treatments also included invasive heart and kidney procedures that research has shown are no better than medicine, and potentially more risky.

WHAT'S NEW: The findings are in an analysis of Medicare claims data for 1.3 million patients in 2009. The researchers devised a list of 26 "low-value" procedures they determined reflect likely overuse. The list was compiled from research evidence and recommendations from several medical groups.

Lead author Aaron Schwartz of Harvard Medical School's health care policy department and colleagues acknowledged that Medicare claims may lack details about patients that might justify some procedures. But using more conservative criteria, they still found that 25 percent of patients received at least one wasteful service, totaling almost $2 billion.

The results, published online Monday in JAMA Internal Medicine, are only a snapshot and the researchers said there are likely many other procedures that are sometimes performed with little benefit for Medicare patients.

"We hope that development of better measures of low-value care will ultimately spur development of interventions to reduce unnecessary care," the journal editors wrote in an editorial.

THE CONTEXT: A 2012 Institute of Medicine report on overall U.S. health spending concluded that about 30 percent, or $750 billion, reflects overtreatment, excessive costs and other problems.

The new study also follows the government's release last month of Medicare billing records for 880,000 physicians and other health care providers, data that consumer advocates and others said might indicate whether some doctors are providing quality cost-effective care or ordering needless services. That data revealed vast differences in Medicare payments, and an agency administrator said Medicare would look into doctors and others who received huge reimbursements, which could suggest overtreatment.

REASONS & REACTIONS: The authors said it's not clear why doctors may be ordering needless services, but that sometimes patients may demand procedures they mistakenly think will benefit them.

Doctors also get paid more for ordering more procedures. And fear of malpractice lawsuits is also often cited as contributing to overtreatment.

Policymakers, doctors and patients themselves should pay attention to the results, the researchers said.

Patients should know they can question their doctors about which procedures are really necessary and whether less invasive and less costly options are available.

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