19 Mar Low-Value Care in Traditional Fee-for-Service Medicare vs Medicare Advantage

MedicalResearch.com Interview with:
Sungchul Park, MPH PhD
Assistant Professor, Health Management and Policy
Dornsife School of Public Health
Drexel University
Philadelphia, PA 19104

MedicalResearch.com: What is the background for this study?

Response: Evidence suggests that a significant share of health care costs in the US is of low value. In some cases, low-value care can be associated with harmful patient outcomes. Thus, decreasing use of low-value care is a major goal for Medicare given the potential to decrease costs and harms. Compared with traditional fee-for-service Medicare (TM), Medicare Advantage (MA) is more strongly financially incentivized to decrease use of low-value care.

MedicalResearch.com: How is low-value care determined?

Response: We identified 13 low-value services in 4 categories based on evidence-based guidelines identifying low-value care. 

MedicalResearch.com: What are the main findings?

Response: We found two key findings. First, use of low-value care was similarly prevalent in Medicare Advantage and TM, suggesting that managed care enrollment is not associated with decreased use of low-value care. Second, there was little evidence for decreases in use of low-value care in TM and MA between 2006 and 2015.

MedicalResearch.com: What should readers take away from your report?

Response: Our findings suggest that neither the current structure of the TM and Medicare Advantage programs not recent efforts to decrease use of low-value care have been associated with significant outcomes.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Despite this limited finding overall, two other findings were notable. First, decreasing rates in the low-value cancer screening composite measure in both programs were of interest. Second, MA enrollees had a higher likelihood of having a low-value imaging composite use compared to TM enrollees in 2006-07, but low-value imaging composite rates remained lower among MA enrollees in later years. Further research is needed to understand the underlying mechanisms for these findings. 

Citation:

Park S, Jung J, Burke RE, Larson EB. Trends in Use of Low-Value Care in Traditional Fee-for-Service Medicare and Medicare Advantage. JAMA Netw Open. 2021;4(3):e211762. doi:10.1001/jamanetworkopen.2021.1762

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Last Updated on March 19, 2021 by Marie Benz MD FAAD