VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
National Clinician Scholars Program, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
J Gen Intern Med. 2021 Dec;36(12):3711-3718. doi: 10.1007/s11606-021-06784-8. Epub 2021 Apr 14.
Low-value care, or patient care that offers no net benefit in specific clinical scenarios, is costly and often associated with patient harm. The US Preventive Services Task Force (USPSTF) Grade D recommendations represent one of the most scientifically sound and frequently delivered groups of low-value services, but a more contemporary measurement of the utilization and spending for Grade D services beyond the small number of previously studied measures is needed.
To estimate utilization and costs of seven USPSTF Grade D services among US Medicare beneficiaries.
We conducted a cross-sectional study of data from the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016 to identify instances of Grade D services.
SETTING/PARTICIPANTS: NAMCS is a nationally representative survey of US ambulatory visits at non-federal and non-hospital-based offices that uses a multistage probability sampling design. We included all visits by Medicare enrollees, which included traditional fee-for-service, Medicare Advantage, supplemental coverage, and dual-eligible Medicare-Medicaid enrollees.
We measured annual utilization of seven Grade D services among adult Medicare patients, using inclusion and exclusion criteria from prior studies and the USPSTF recommendations. We calculated annual costs by multiplying annual utilization counts by mean per-unit costs of services using publicly available sources.
During the study period, we identified 95,121 unweighted Medicare patient visits, representing approximately 2.4 billion visits. Each year, these seven Grade D services were utilized 31.1 million times for Medicare beneficiaries and cost $477,891,886. Three services-screening for asymptomatic bacteriuria, vitamin D supplements for fracture prevention, and colorectal cancer screening for adults over 85 years-comprised $322,382,772, or two-thirds of the annual costs of the Grade D services measured in this study.
US Medicare beneficiaries frequently received a group of rigorously defined and costly low-value preventive services. Spending on low-value preventive care concentrated among a small subset of measures, representing important opportunities to safely lower US health care spending while improving the quality of care.
低价值医疗，即在特定临床情况下无法提供净收益的患者医疗，既耗费成本，又常导致患者受害。美国预防服务工作组（USPSTF）的 D 级推荐是最科学合理且最常实施的低价值服务之一，但需要对除之前研究的少数措施之外的 D 级服务的利用率和支出进行更具当代性的衡量。
估算美国 Medicare 受益人群中七种 USPSTF D 级服务的利用率和成本。
我们对 2007 年至 2016 年全国门诊医疗调查（NAMCS）的数据进行了横断面研究，以确定 D 级服务的实例。
设置/参与者：NAMCS 是一项针对非联邦和非医院基础办公场所的美国门诊就诊的全国代表性调查，采用多阶段概率抽样设计。我们纳入了 Medicare 参保者的所有就诊，包括传统的按服务收费、医疗保险优势计划、补充保险和双重资格的 Medicare-Medicaid 参保者。
我们使用先前研究和 USPSTF 建议的纳入和排除标准，衡量成年 Medicare 患者中七种 D 级服务的年度利用率。我们通过将每年的利用次数乘以公共来源提供的服务单位平均成本来计算每年的成本。
在研究期间，我们确定了 95121 个未经加权的 Medicare 患者就诊，代表了约 24 亿次就诊。每年，这七种 D 级服务被 Medicare 受益人群利用了 3110 万次，花费 477891886 美元。三项服务-无症状菌尿筛查、维生素 D 补充剂预防骨折和 85 岁以上成年人的结直肠癌筛查-占 322382772 美元，或本研究中衡量的 D 级服务年度成本的三分之二。
美国 Medicare 受益人群经常接受一组严格定义且成本高昂的低价值预防服务。低价值预防保健支出集中在少数措施上，这为安全降低美国医疗保健支出同时提高医疗质量提供了重要机会。
