Overused Medical Services Cost Up to $8.5 Billion

Although a spotlight has been placed on medical overtreatment and its extra cost to the healthcare system, measuring wasteful healthcare use has been difficult, according to a new study from the Harvard Medical School (HMS) Department of Health Care Policy.

According to the research, published in JAMA Internal Medicine, Medicare spent at least $1.9 billion and up to $8.5 billion in 2009 for 26 tests and procedures shown to offer little or no health benefit. At least one in 4 Medicare recipients received one or more of these services.

J. Michael McWilliams, the study author, associate professor of healthcare policy at HMS, and a practicing general internist at Brigham and Women’s Hospital, suspects the data in the study is “just the tip of the iceberg.” The 26 tests and procedures were just a sample of the services known to provide little or no medical value in many circumstances.

“Some tests and treatments that are wasteful across the board are easy targets—we can stop paying for them,” he said in a statement. “But for most services, incentives that allow providers greater discretion at the point of care may be needed to cut significant amounts of waste while minimizing unintended consequences

The researchers detected use and spending in 6 categories of low-value services: low-value cancer screening; low-value diagnostic and preventive testing; low-value preoperative testing; low-value imaging; low-value cardiovascular testing and procedures; and other low-value surgical procedures.

The Choosing Wisely campaign has drawn attention to low-value and potentially wasteful services. The campaign has published lists of the tests and procedures that may be unnecessary in various specialties.

Depending on the criteria used to count wasteful instances, the amount of waste measured varied greatly. Using a broad definition, these services affected 42% of beneficiaries and cost $8.5 billion. However, using a narrow definition, 25% of beneficiaries received at least one of the wasteful services, resulting in $1.9 billion in Medicare spending.

“We were surprised that these wasteful services were so prevalent,” Aaron Schwartz, an MD/PhD student in the HMS Department of Health Care Policy and lead author of the study, said in a statement. “Even just looking at a fraction of wasteful services and using our narrowest definitions of waste, we found that one quarter of Medicare beneficiaries undergo procedures or tests that don’t tend to help them get better.”