In this issue:
  • Audit and Feedback — Optimizing a Strategy to Reduce Low-Value Care
  • Characteristics Associated with Low-Value Cancer Screening
  • State-Level Variation in Low-Value Care for Commercially Insured & Medicare Advantage
  • Effect of 2012 USPSTF Recommendations on Prostate-Specific Antigen Screening
  • Evaluation of Prior Authorization in Medicare Non-emergent Ambulance Support
  • Evaluation of a Best Practice Advisory on Test Ordering
  • Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

Audit and Feedback—Optimizing a Strategy to Reduce Low-Value Care

A JAMA study provides high-quality evidence that a national audit and feedback program might help reduce widespread use of low-value testing. Audit letters provided individual physicians with their ordering rates and percentile rankings compared with peers. The study reports a significant 10% reduction of orders for 11 imaging tests over 12 months, suggesting that audit and feedback interventions may serve to change clinician behavior, and thus reduce low-value care. Read more here.

Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries

A new study explores whether network design, product design, value-based payment, or utilization management moderate differences in rates of low-value care delivery between MA and TM beneficiaries. Authors report that MA beneficiaries received 9.2% fewer low-value services than TM beneficiaries in 2019, concluding that certain elements of insurance design present in MA plans are associated with lower rates of low-value care.

Characteristics Associated with Low-Value Cancer Screening Among Office-Based Physician visits by Older Adults in the U.S.A.

To estimate the frequency of low-value cervical, breast, and colorectal cancer screening in older adults in the U.S., USPSTF age thresholds were applied to pooled cross-sectional data (2011–2016) from the National Ambulatory Medical Care Survey. Age, race/ethnicity, and physician specialty are associated with receiving low-value cancer screenings

State-Level Variation In Low-Value Care For Commercially Insured And Medicare Advantage Populations

A new study shows that low-value care remains prevalent among Medicare Advantage enrollees, with 23 services accounting for $3.7B in wasteful spending from 2009-2019. Findings suggest that state-level variation in spending was greater than variation in utilization, with much driven by differences in average procedure prices. If the average price for 23 low-value services among the top ten states in spending were set to the national average, their spending would decrease by 19.8%.

Effect of the 2012 U.S. Preventive Services Task Force Recommendations on Prostate-Specific Antigen Screening in a Medicare Advantage Population

In 2012, the USPSTF revised its recommendations for PSA screening from “insufficient evidence” to “do not recommend” for men aged 70–74, while maintaining “do not recommend” for men aged 75+, expecting to change behaviors among those aged 70–74. Findings from a recent study, however, show that care practices have not adjusted accordingly, noting a 3% increase since 2012 for both groups, particularly after reduction in patient out-of-pocket costs in 2016.

Evaluation of Prior Authorization in Medicare Nonemergent Ambulance Support

Prior authorization for targeted medications or services can lead to reduced spending, but there is limited evidence on how this affects patient outcomes and access to care. Findings from a recent JAMA study focused on prior authorization for nonemergency ambulance services in Medicare suggest that targeted approaches to prior authorization may be an appropriate control measure for Medicare services vulnerable to improper use.

Evaluation of a Best Practice Advisory on Ordering Prothrombin Time, International Normalized Ratio, and Partial Thromboplastin Time Tests

“A pandemic-created natural experiment highlighted the effectiveness of a BPA added to clinician communication to reduce potentially unnecessary care,” authors of a recent JAMA research letter state. In the wake of COVID-19, demand for citrate products increased drastically due to their use in vaccine development and therapeutics, leading to a USFDA documented shortage. Authors evaluated the BPA issued in response to the shortage, and found that it was associated with an immediate and persistent decrease in ordering of PT, INR, and PTT testing.

Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

Studies estimate that 53.6M Americans have osteoporosis, low bone mass, or both. Vitamin D supplements are widely recommended to the general population to promote bone health, but fractures continue to be a major public health concern. Findings from a recent study show that Vitamin D3 supplements did not result in a significantly lower risk of fractures among generally healthy midlife and older adults.

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