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Low-Value Health Services Are Costly, But Relatively Uncommon

October 13th, 2016

BOSTON – Overuse of low-value health services among adult commercial health insurance beneficiaries isn’t that widespread, according to a new study, but limiting them still could save significant expenses.

The research letter published in JAMA Internal Medicine reported, for the first time, the range of low-value health services used by that group, according to the RAND Corp.-led study team.

For the study, researchers examined insurance claims from more than 1.46 million adults from across the country, determining that spending on 28 low-value medical services added up to $32.8 million during 2013 among the commercially-insured adult group.

That figure represents about 0.5% of total spending -- or more than $22 per person annually, according to the article.

Hormone tests for thyroid problems, imaging for low-back pain, and imaging for uncomplicated headache were the most common low-value services, the report states.

Results indicate that the greatest proportion of spending, however, was for spinal injection for lower-back pain at $12.1 million, imaging for uncomplicated headache at $3.6 million and imaging for nonspecific low-back pain at $3.1 million.

Those are among 28 medical services categorized in previous research as providing little value to patients based on cost and available alternatives. The study reports that 7.8% of the commercially insured patients received low-value services in 2013, and that low-value spending was less common among patients who were older, male, black, or Asian, lower-income, or enrolled in consumer-directed health plans, which have high member cost-sharing.

“Our findings add evidence to the notion that reducing overuse of medical procedures could improve quality while reducing spending,” said lead author Rachel Reid, MD, MS, a physician scientist at RAND, a nonprofit research organization.

In 2012, the American Board of Internal Medicine Foundation and consumer groups launched an initiative called Choosing Wisely to encourage physicians and patients to avoid $200 billion in overtreatment.

“The services in this study reflect many clinical areas and types of care, but still are a small portion of all the low-value care patients receive,” Reid said in a RAND press release. “The potential savings from reducing these low-value services and others are substantial.”

Unlike previous studies, which focused on low-value medical care in Medicare recipients or narrower regions, the current study conducted with the University of Southern California (USC) evaluated medical services provided to an extensive group of nonelderly adults insured through one of the nation's largest commercial health insurance companies.

Results indicate that, regionally, the Southern, Middle Atlantic and Mountain regions had proportionately more low-value spending.

“Areas with high Medicare spending also seem to have greater use of low-value services among those with commercial insurance,” said senior author Neeraj Sood, PhD, director of research at the Leonard D. Schaeffer Center for Health Policy at USC. “This confirms that there are opportunities for cost savings, and that both private insurers and Medicare can benefit from efforts to reduce use of low-value care.”