Primary care docs make up minority of spending on low-value care, study finds

Low-value spending—that is, costs incurred for services that experts in the field agree aren't very valuable—is less likely to occur due to primary care docs compared to other physicians, a new research report concluded. 

Published in the Annals of Internal Medicine, researchers from the Icahn School of Medicine at Mount Sinai, the American Board of Family Medicine, Collective Health, Stanford University Medical Center and the Center for Professionalism and Value in Healthcare analyzed Medicare Part B claims between 2007 and 2014. In the retrospective study, they were looking for an estimate of the share of beneficiaries' low-value spending directly related to their primary care physician's services or referrals. 

Those low-value services including 31 services previously determined by national physicians' societies, Medicare criteria and clinical guidelines to be "low value." Examples included, they said, imaging for nonspecific back pain, PSA screening for men older than 75 and arthroscopic surgery for knee osteoarthritis. 

"Low-value services account for $75 billion to $100 billion of U.S. health care spending," the authors wrote. "Primary care physicians have been conceptualized as potential gatekeepers for efforts to reduce low-value spending, but the share of low-value spending directly related to their services and referral decisions remains unclear."

RELATED: Low-cost, low-value care accounts for a substantial amount of unnecessary spending

However, the research report found, for the majority of primary care docs, services performed or ordered accounted for less than 9% of their patients’ low-value spending. That amounted to less than 0.3% of their total Medicare Part B spending.

Most primary care physician referrals accounted for less than 16% of their patient's low-value spending or less than 0.5% of their total Medicare Part B spending.

The authors acknowledged limitations of the study included the concern that the findings are dependent on the low-value services analyzed, that some services may have been misclassified as low-value and that the analysis excluded hospital outpatient services because those claims do not identify the referring physician.

They said future research should look into the practice patterns of outlier physicians responsible for a major share of their patients' low-value spending, as well as referral tools and payment strategies that facilitate physicians' management of low-value care and methods to minimize low-value measurement burden in primary care.