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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