Managed Medicare plans fall short at cutting unnecessary imaging and other low-value care
Managed Medicare plans have not had a significant effect on decreasing low-value care—including imaging and cancer screenings—compared to traditional fee-for-service plans, according to an analysis published Wednesday.
Services that offer little to no clinical benefit, such as imaging for back pain or headache, account for up to 2.7% of annual healthcare spending or about $75.7 billion, researchers explained in JAMA Network Open.
Despite the national health program’s goal to reduce low-value care, its utilization has been similar across both traditional Medicare and Medicare Advantage enrollees over a nearly 10-year period ending in 2015.
“We found that use of low-value care in Medicare Advantage was as prevalent as in TM during the study period, suggesting that the structure of MA may not be associated with decreases in [the] use of low-value care,” Sungchul Park, PhD, MPH, a health management and policy expert at Drexel University, and colleagues explained on March 17.
For their cross-sectional study, the team utilized data from the 2006 to 2015 Medical Expenditure Panel Survey. In total, they picked 13 low-value services including, cervical, colorectal and prostate cancer screening in older adults; MRI, CT, or radiography for back pain; and MRI and CT for headache.
Park and co-investigators gathered information on individuals eligible for such services and whether they received low-value care.
One of the group’s main takeaways was that the use of most low-value services was higher among patients enrolled in managed care compared to traditional Medicare plans, but a majority of differences were insignificant.
Park and colleagues performed further analysis, including low-value composite measures to capture the use of specific low-value testing. For this, they reported two “notable” findings that relate to the radiology community.
For one, low-value cancer screening composite rates decreased across both programs, the authors found. This may suggest that it requires time to see significant change, possibly due to low participation early on and lags in changing practice patterns, the authors wrote.
Furthermore, Medicare Advantage enrollees were more likely to have a higher low-value imaging composite measure compared to traditional Medicare participants in 2006 to 2007. But this trend reversed from 2012 to 2013, with traditional Medicare participants showing higher rates.
“This may suggest that decreases in [the] use of some low-value services are partly associated with MA’s more recent efforts to decrease low-value imaging services that are costly,” Park and co-authors explained.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.