Analysis of Medicare Claims Data Reveals Significant Spending on Low-Value Services

Editor’s Note: September is Suicide Prevention Month. If you know someone in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), 24 hours a day, seven days a week. All calls are confidential. You can also visit the Lifeline’s website.

AHRQ Stats: Areas Where Emergency Care Related to Suicide Is Most Common

In 2017, among 5- to 24-year-olds, the rate of emergency department visits related to suicidal ideation or suicide attempt was higher in small to medium metro areas and rural areas, as compared with large metro areas. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #263: Emergency Department Visits Related to Suicidal Ideation or Suicide Attempt, 2008-2017.) 

Today's Headlines:

• Analysis of Medicare Claims Data Reveals Significant Spending on Low-Value Services.
• Highlights From AHRQ’s Patient Safety Network.
• Study Finds Medicare Incentives Program Effective in Reducing Hospital Readmissions.
• Apply by January 25 for Funding To Disseminate Evidence Into Practice Through Clinical Decision Support.
• Register Now for September 15 and 17 Webinars on Understanding Clinical Quality Measures.
• AHRQ in the Professional Literature.

Analysis of Medicare Claims Data Reveals Significant Spending on Low-Value Services

More than one in three Medicare beneficiaries received at least one low-value service in 2017, according to an AHRQ-funded study published in the Journal of General Internal Medicine (JGIM). The authors examined claims reflecting Choosing Wisely® recommendations and other guidelines for all 15,168,134 Medicare fee-for-service beneficiaries, 65 years of age or older, who were continuously enrolled in parts A, B or D for at least two years. They found that these beneficiaries received about 10 million distinct low-value services—those offering patients little to no clinical benefit—resulting in about $2.1 billion in wasteful claim-level spending. Opioids prescribed for acute low back pain, preoperative baseline laboratory studies and oral antibiotics for acute upper respiratory or external ear infections were identified as the three most frequent services. The authors suggested that targeted interventions to reduce low-value services could greatly reduce wasteful spending in Medicare. Access the abstract.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Association of implementation and social network factors with patient safety culture in medical homes: a coincidence analysis.
• Clarifying radiology's role in safety events: a 5-year retrospective common cause analysis of safety events at a pediatric hospital.
• Association between implementing comprehensive learning collaborative strategies in a statewide collaborative and changes in hospital safety culture.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Study Finds Medicare Incentives Program Effective in Reducing Hospital Readmissions

Hospitals with greater financial incentives for avoiding readmissions have larger decreases in readmissions compared with hospitals with smaller incentives, according to a new AHRQ-funded study published in JAMA Network Open. The finding was consistent across conditions and procedures, with the largest reductions in readmissions for hip and/or knee surgery (5.8 percent) and acute myocardial infarction (3.8 percent), compared with hospitals with no incentives. Conversely, hospitals with no such incentives experienced increases in excess readmissions across five Hospital Readmissions Reduction Program-targeted conditions. The authors reviewed Medicare readmissions data from 2,823 U.S. short-term acute care hospitals participating in the Hospital Readmissions Reduction Program to compare readmissions between 2016 and 2019. Access the abstract.

Apply by January 25 for Funding To Disseminate Evidence Into Practice Through Clinical Decision Support

AHRQ funding is available for R18 research grants to disseminate and implement patient-centered outcomes research evidence into clinical practice by scaling shared, interoperable clinical decision support (CDS). AHRQ’s funding opportunity announcement focuses on expanding interoperable CDS across different healthcare systems and technologies, including different electronic health records (EHRs), and disseminating lessons learned about how to achieve CDS scalability and interoperability. Research projects are expected to explore how healthcare systems can effectively share and re-use standards-based CDS even where differences exist among EHRs, workflows and end-users. The first standard due date for applications is Jan. 25, 2021. Access the funding opportunity announcement, “Disseminating and Implementing Patient-Centered Outcomes Research Evidence into Practice through Interoperable Clinical Decision Support (R18).”

September 15 and 17 Webinars on Understanding Clinical Quality Measures

Webinars from the Centers for Medicare & Medicaid Services (CMS) "Understanding Clinical Quality Measures: How CMS is Modernizing its Approach to Digital Measurement." on Sept. 15 from 2 to 3 p.m. ET and Sept. 17 from 3 to 4 p.m. ET will provide an overview of quality measurement, the unique features of electronic clinical quality measures and CMS’ future plans for digitization. The webinars also will address burden reduction, measure reporting considerations and provide some key resources. Space is limited, and registration is required. Contact MMSSupport@battelle.org to learn more.

AHRQ in the Professional Literature

Inpatient morbidity and mortality of measles in the United States. Chovatiya R, Silverberg JI. PLoS One 2020 Apr 28;15(4):e0231329. Access the abstract on PubMed®.

Contributing factors for pediatric ambulatory diagnostic process errors: Project RedDE. Dadlez NM, Adelman J, Bundy DG, et al. Pediatr Qual Saf 2020 May 12;5(3):e299. Access the abstract on PubMed®.

Evaluation of Medicaid Expansion under the Affordable Care Act and contraceptive care in US community health centers. Darney BG, Jacob RL, Hoopes M, et al. JAMA Netw Open 2020 Jun 1;3(6):e206874. Access the abstract on PubMed®.

Clinical overview of NMDA-R antagonists and clinical practice. Davoudian PA, Wilkinson ST. Adv Pharmacol 2020;89:103-29. Epub 2020 Jun 1. Access the abstract on PubMed®.

Exploring the digital divide: age and race disparities in use of an inpatient portal. Walker DM, Hefner JL, Fareed N, et al. Telemed J E Health 2020 May;26(5):603-13. Epub 2019 Jul 9. Access the abstract on PubMed®.

How practice facilitation strategies differ by practice context. Nguyen AM, Cuthel A, Padgett DK, et al. J Gen Intern Med 2020 Mar;35(3):824-31. Epub 2019 Oct 21. Access the abstract on PubMed®.

Hospital adoption of multiple health information exchange approaches and information accessibility. Everson J, Butler E. J Am Med Inform Assoc. 2020 Apr 1;27(4):577-83. Epub 2020 Feb 13. Access the abstract on PubMed®.

The relationship of loneliness to end-of-life experience in older Americans: a cohort study. Abedini NC, Choi H, Wei MY, et al. J Am Geriatr Soc 2020 May;68(5):1064-71. Epub 2020 Mar 3. Access the abstract on PubMed®.