During its April 7-8 meeting, the Medicare Payment Advisory Commission (MedPAC) discussed the impact of low-value health care and its implications for the Medicare program.
MedPAC defines low-value care as services having little or no clinical benefit in which the risk of harm from a service outweighs its potential benefit. According to MedPAC, cardiovascular tests and procedures, other surgical procedures and imaging services, such as imaging for low back pain, has accounted for most low value-care spending.
MedPAC’s analysis suggests that low-value care increases health care costs and has the potential to harm patients by exposing them to the risks of injury from inappropriate tests or procedures, leading to a cascade of additional services that raise the risk of poor outcomes but provide little or no clinical benefit.
Members of the MedPAC Commission discussed prior authorization to reduce the use of low-value services. Clinical decision support (CDS) was then considered, with a few commissioners expressing a preference for CDS instead of prior authorization because of CDS’s advantages at the point of care. They also acknowledged that prior authorization would be problematic in some alternative payment models, such as the Comprehensive Joint Replacement (CJR) where it would delay patient discharges.
ACR staff routinely monitors MedPAC and will keep the College’s members informed about its activities.