Primary docs don't spend much on low-value care

By Rebekah Moan, AuntMinnie.com contributing writer

January 20, 2021 -- Primary care physician (PCP) services and referrals account for a small minority of spending on low-value care such as imaging for nonspecific back pain, according to a January 19 study in the Annals of Internal Medicine.

Spending on low-value healthcare services is estimated to cost healthcare systems $75 billion to $100 billion annually. But how much of that spending is directly related to services and referral decisions by primary care physicians?

A research team led by Aaron Baum, PhD, from the American Board of Family Medicine and Mount Sinai, along with colleagues at Harvard and Stanford universities, started with a set of 31 services previously classified as low-value by national physician societies, Medicare criteria, and clinical guidelines.

The group then analyzed Medicare Part B claims between 2007 and 2014 to estimate the share of Medicare beneficiaries' low-value spending that was directly related to services or referrals from primary care physicians.

It turns out that PCP contributions made up a relatively small portion of the low-value expenditures -- services primary care doctors performed or ordered accounted for less than 9% of patients' low-value spending, and services they referred accounted for a median of 15.4% of spending on low-value services.

Share of spending on low-value imaging services, by physician referral type
  Performed or ordered by PCP Referred by PCP Referred Previously by PCP Referred by non-PCP
Back imaging for nonspecific low back pain 23% 6% 2% 69%
Head imaging for uncomplicated headache 29% 2% 1% 68%
Preoperative chest radiography 30% 2% 1% 68%
Head imaging in the evaluation of syncope 23% 2% 1% 75%
CT of the sinuses for uncomplicated acute rhinosinusitis 17% 8% 4% 71%
Imaging for the diagnosis of plantar fasciitis 2% 21% 4% 74%
Total spending on low-value services (including nonimaging) 15% 20% 6% 60%

The medical specialties that accounted for the largest share of low-value spending were cardiology (27.3%), primary care (14.5%), ambulatory surgical centers (8.9%), internal medicine (7%), and orthopedic surgery (4.9%).

For future research, Baum et al recommended studies on practice patterns of primary care physicians who are outliers from the norm in terms of spending on low-value services. Studies could also investigate referral tools and payment strategies to help primary doctors manage low-value care, as well as methods for minimizing the difficulty of measuring the burden of low-value care in the primary area.


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