Primary Care Physicians and Spending on Low-Value Care

LettersJune 2021Primary Care Physicians and Spending on Low-Value CareAaron Baum, PhD, Andrew Bazemore, MD, MPH, Lars Peterson, MD, PhD, Sanjay Basu, MD, PhD, Keith Humphreys, PhD, and Robert L. Phillips, MD, MPHAaron Baum, PhDIcahn School of Medicine at Mount Sinai, New York, New York, Andrew Bazemore, MD, MPHAmerican Board of Family Medicine, Lexington, Kentucky, Lars Peterson, MD, PhDAmerican Board of Family Medicine, Lexington, Kentucky, Sanjay Basu, MD, PhDCollective Health, San Francisco, California, Keith Humphreys, PhDCenter for Innovation to Implementation, Veterans Affairs and Stanford University Medical Centers, Palo Alto, California, and Robert L. Phillips, MD, MPHCenter for Professionalism and Value in Health Care, Washington, DCAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-6257 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Low-value services account for $75 billion to $100 billion of U.S. health care spending (1). Primary care physicians (PCPs) 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 (2, 3).Objective: To estimate the share of low-value spending on Medicare beneficiaries that is directly related to their attributed PCP's services or referrals.Methods and Findings: We analyzed Medicare Part B claims from a 20% random sample of beneficiaries enrolled between 2007 and 2014. The study population included beneficiaries who were ...References1. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322:1501-1509. [PMID: 31589283] doi:10.1001/jama.2019.13978 CrossrefMedlineGoogle Scholar2. Schwartz AL, Jena AB, Zaslavsky AM, et al. Analysis of physician variation in provision of low-value services. JAMA Intern Med. 2019;179:16-25. [PMID: 30508010] doi:10.1001/jamainternmed.2018.5086 CrossrefMedlineGoogle Scholar3. Barreto TW, Chung Y, Wingrove P, et al. Primary care physician characteristics associated with low value care spending. J Am Board Fam Med. 2019;32:218-225. [PMID: 30850458] doi:10.3122/jabfm.2019.02.180111 CrossrefMedlineGoogle Scholar4. Mafi JN, Russell K, Bortz BA, et al. Low-cost, high-volume health services contribute the most to unnecessary health spending. Health Aff (Millwood). 2017;36:1701-1704. [PMID: 28971913] doi:10.1377/hlthaff.2017.0385 CrossrefMedlineGoogle Scholar5. Morden NE, Colla CH, Sequist TD, et al. Choosing wisely—the politics and economics of labeling low-value services. N Engl J Med. 2014;370:589-92. [PMID: 24450859] doi:10.1056/NEJMp1314965 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Icahn School of Medicine at Mount Sinai, New York, New YorkAmerican Board of Family Medicine, Lexington, KentuckyCollective Health, San Francisco, CaliforniaCenter for Innovation to Implementation, Veterans Affairs and Stanford University Medical Centers, Palo Alto, CaliforniaCenter for Professionalism and Value in Health Care, Washington, DCNote: Dr. Baum had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Board of Family Medicine Foundation or Stanford University.Financial Support: By the American Board of Family Medicine Foundation. Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core, which is supported by a National Institutes of Health National Center for Advancing Translational Sciences Clinical and Translational Science Award (UL1 TR001085) and by Stanford University. The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-6257.Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. Baum (e-mail, aaron.[email protected]edu).Corresponding Author: Aaron Baum, PhD, Department of Health System Design, Icahn School of Medicine at Mount Sinai, 1216 Fifth Avenue, Suite 556, New York, NY 10029; e-mail, aaron.[email protected]edu.This article was published at Annals.org on 19 January 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPerformance on Patient Experience Measures of Former Chief Medical Residents as Physician Exemplars Chosen by the ProfessionOrganizational influences on the use of low-value care in primary health care – a qualitative interview study with physicians in SwedenUpdating a Claims-Based Measure of Low-Value Services Applicable to Medicare Fee-for-Service BeneficiariesHealth Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional AnalysisLow-Value Care at the Actionable Level of Individual Health SystemsWhich Medical Professions Are Ordering the Most Low-Value Care? June 2021Volume 174, Issue 6Page: 875-878KeywordsDisclosureHealth careInstitutional review boardsInterquartile rangeMedicareOrthopedic surgeryOutpatient clinicsPrimary carePrimary care physiciansRetrospective studies ePublished: 19 January 2021 Issue Published: June 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...