- Medicare could save $3.6B without risk to older adults, study suggests
- WISeR (Wasteful and Inappropriate Service Reduction) Model
- A quarter of hospitalized Medicare patients experience preventable harm, report finds
- Waste of the Day: “Low-Value” Medicare Treatments
- Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare
- Continuous Glucose Monitor Use—Avoiding Overuse
- CMS Should Improve Its Methodology for Collecting Medicare Postoperative Visit Data
- The Impact of Definitions of Disease on Overdiagnosis
- Estimating the societal costs and benefits of de-implementation of low-value care
A recent JAMA Health Forum article estimates Medicare could save up to $3.6 billion annually by eliminating a small set of low-value tests and procedures. “Patients who can benefit from these services should absolutely receive them,” said Dr. Mark Fendrick, “but we show that tremendous savings could be achieved by avoiding them in patients who won’t benefit or could be harmed.” He called it a “clinically driven, patient-focused approach” that supports policy efforts to reduce waste and reinvest in high-value care. Read more here.
WISeR (Wasteful and Inappropriate Service Reduction) Model
CMS announced the Wasteful and Inappropriate Service Reduction (WISeR) Model that is aimed to help reduce clinically unsupported care by using enhanced technologies to expedite and improve the review process for a pre-selected set of services that are vulnerable to fraud, waste and abuse. The voluntary model will encourage care navigation, encouraging safe and evidence-supported best practices for treating people with Medicare. WISeR will run for six performance years from January 1, 2026 to December 31, 2031.
A quarter of hospitalized Medicare patients experience preventable harm, report finds
A report from the Department of Health and Human Services’ Office of Inspector General found that one-quarter of hospitalized Medicare patients experienced preventable harm in October 2018. The report highlights the need for improved incident reporting systems and a standardized definition of patient harm to enhance patient safety. It recommends a national effort to align definitions and create a classification of patient harm to support hospitals in capturing and addressing these events. Read more here.
Waste of the Day: “Low-Value” Medicare Treatments
Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare
A recent Journal of Clinical Oncology study found that Medicare Advantage (MA) enrollees were slightly less likely than those in Traditional Medicare (TM) to receive low-value cancer treatments (34.2% vs. 35.9%). MA plans used tools like prior authorization and step therapy to curb unnecessary care, especially for costly drugs and low-risk interventions. However, variation among MA insurers suggests room for improvement across both programs. Read more here.
Continuous Glucose Monitor Use—Avoiding Overuse
A recent JAMA Internal Medicine commentary examines the growing use—and potential overuse—of continuous glucose monitors (CGMs) in non-diabetic contexts. It presents a case of a non-diabetic patient experiencing anxiety and sleep disturbances after repeated low-glucose alerts that weren’t clinically confirmed. The authors emphasize the importance of verifying CGM readings with fingerstick tests, highlighting that excessive reliance on CGMs without appropriate context can cause unnecessary stress and medical overuse. They call for more judicious, evidence-guided use of CGMs to avoid unintended harm.
CMS Should Improve Its Methodology for Collecting Medicare Postoperative Visit Data on Global Surgeries
An Office of the Inspector General (OIG) audit found that Medicare is overpaying for global surgery procedures because postoperative evaluation and management visits, included in bundled payments aren’t actually provided. For 91 out of 105 surgeries reviewed, the number of follow-up visits was overstated, resulting in an estimated $5.7 million in excess Medicare spending and $1.7 million in extra patient costs. Additionally, CMS data for nearly half of the sampled procedures was inaccurate, which limits its potential usefulness for setting appropriate payment rates. OIG recommended CMS take steps to improve data accuracy and align payment rates with actual service utilization.
The Impact of Definitions of Disease on Overdiagnosis
A recent JAMA Internal Medicine article highlights how expanding disease definitions—such as lowering thresholds for cholesterol, blood pressure, or gestational diabetes—can medicalize normal variations and dramatically inflate disease prevalence, straining health system resources. Authors warn that overdiagnosis and overtreatment may follow due to overly broad criteria. They call on researchers, clinicians, and policymakers to rigorously evaluate whether broadened definitions truly benefit patients or simply fuel unnecessary care.
Estimating the societal costs and benefits of de-implementation of low-value care: developing a modelling approach through case assessment
A recent study in BMC Health Services Research presents a new model to estimate the societal costs and benefits of de-implementing low-value care. Using real-world case studies like Achilles tendon surgery and low back pain imaging, the approach accounts for broader impacts beyond direct medical savings. The findings show the model is feasible and can inform smarter health policy decisions, though more work is needed to capture full implementation costs.
