학술논문

The Utilization and Costs of Grade D USPSTF Services in Medicare, 2007–2016
Document Type
article
Source
Journal of General Internal Medicine. 36(12)
Subject
Health Services and Systems
Health Sciences
Clinical Research
Prevention
Health Services
Aging
8.1 Organisation and delivery of services
Good Health and Well Being
Aged
Cross-Sectional Studies
Fee-for-Service Plans
Humans
Low-Value Care
Medicare
Preventive Health Services
United States
USPSTF
low-value care
quality
value
Clinical Sciences
General & Internal Medicine
Clinical sciences
Health services and systems
Public health
Language
Abstract
BackgroundLow-value care, or patient care that offers no net benefit in specific clinical scenarios, is costly and often associated with patient harm. The US Preventive Services Task Force (USPSTF) Grade D recommendations represent one of the most scientifically sound and frequently delivered groups of low-value services, but a more contemporary measurement of the utilization and spending for Grade D services beyond the small number of previously studied measures is needed.ObjectiveTo estimate utilization and costs of seven USPSTF Grade D services among US Medicare beneficiaries.DesignWe conducted a cross-sectional study of data from the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016 to identify instances of Grade D services.Setting/participantsNAMCS is a nationally representative survey of US ambulatory visits at non-federal and non-hospital-based offices that uses a multistage probability sampling design. We included all visits by Medicare enrollees, which included traditional fee-for-service, Medicare Advantage, supplemental coverage, and dual-eligible Medicare-Medicaid enrollees.Main measuresWe measured annual utilization of seven Grade D services among adult Medicare patients, using inclusion and exclusion criteria from prior studies and the USPSTF recommendations. We calculated annual costs by multiplying annual utilization counts by mean per-unit costs of services using publicly available sources.Key resultsDuring the study period, we identified 95,121 unweighted Medicare patient visits, representing approximately 2.4 billion visits. Each year, these seven Grade D services were utilized 31.1 million times for Medicare beneficiaries and cost $477,891,886. Three services-screening for asymptomatic bacteriuria, vitamin D supplements for fracture prevention, and colorectal cancer screening for adults over 85 years-comprised $322,382,772, or two-thirds of the annual costs of the Grade D services measured in this study.ConclusionsUS Medicare beneficiaries frequently received a group of rigorously defined and costly low-value preventive services. Spending on low-value preventive care concentrated among a small subset of measures, representing important opportunities to safely lower US health care spending while improving the quality of care.