'Low-value' imaging tests cost Medicare billions annually

Overused medical services--many of which are imaging related--cost Medicare billions of dollars of year, according to a study published in the journal JAMA Internal Medicine.

The study, carried out by researchers from the Harvard Medical School Department of Health Care Policy, evaluated 26 tests and procedures that have been determined to have little or no clinical benefit, as determined by sources such as the Choosing Wisely campaign and the U.S. Preventive Services Task Force.

Of the 26 tests and procedures evaluated, ones relating to medical imaging included imaging for nonspecific low-back pain; carotid screening for asymptomatic patients; bone mineral density testing at frequent intervals; colon cancer screening for elderly patients; preoperative chest radiography; head imaging for headache; head imaging for syncope; and CT for rhinosinusitis.

The researchers found that at least one in four Medicare beneficiaries received one of the 26 services during 2009, and suggested that the number of beneficiaries who underwent unnecessary tests was certainly more than that, considering they looked at just the 26 tests.

"There are hundreds of other low-value services," study co-author J. Michael McWilliams, a professor at Harvard Medical School Department of Health Care Policy, told NPR.org.

For the study, the authors analyzed Medicare billing records in two ways: The more inclusive method captured more potential inappropriate use, and through use of this measure, the authors found that spending for these services added about $8.5 billion for the entire Medicare system. Alternately, the authors used more selective measures, which found that Medicare spending on low-value services was $1.9 billion.

The gap using the broader versus more limited methods of determining inappropriate use demonstrates why it may be difficult to properly monitor these tests, according to the researchers. They suggested that payment models such as bundled payments--rather than fee for service models--could give providers more discretion in identifying low-value services, as well as provide them with an incentive to eliminate them.

Similar research published in JAMA Internal Medicine in February found that healthcare providers could significantly reduce costs if they eschewed five low-value, often unnecessary emergency medicine procedures; four of the five procedures were imaging-related.

To learn more:
- see the study in JAMA Internal Medicine
- read the article on NPR.org

Suggested Articles

The Texas Health and Human Services Commission was hit with a $1.6 million fine for violating HIPAA privacy and security rules.

Ryan Schmid, the co-founder of Vera Whole Health, says the key to create a health revolution lies in advanced primary care.

American Well plans to acquire Aligned Telehealth in a move that strengthens its virtual care capabilities in behavioral health and telepsychiatry.