​Overuse of low-value care among uninsured or Medicare-insured patients is common, but not significantly more so than among privately insured patients, according to an original investigation published in the June 2017 issue of JAMA Internal Medicine. Wasteful spending on low-value services is a leading source of unnecessary costs in healthcare, the authors said, and its elimination is particularly valuable in safety-net settings where physicians have limited financial resources. Examples of low-value care include prescribing antibiotics for upper respiratory infections, nonindicated screening tests during general medical examinations, and inappropriate prescribing of narcotics. The authors looked at survey data from 193,062 physician office visits between 2005 and 2013. They divided patients by insurance status and whether they were seeing a safety-net physician and compared them with the delivery of any of nine low-value care measures or 12 high-value care measures. In all, 19.4% of visits featured the delivery of low-value services and 33.4% saw delivery of high-value services. The rates were similar regardless of the type of insurance the patient had. The results were surprising to the authors, noting it would be a "reasonable hypothesis" to assume patients with no insurance or Medicare would receive more low-value services. The findings reveal that physicians do not systematically discriminate in treatment patterns based on insurance coverage, the authors said, adding that "ingrained patterns of overuse among physicians appear to transcend the insurance status of the individual patient." The study also indicated that low-value care does not occur more frequently in a safety-net setting. This is important, the authors said, because "many policy proposals aimed at Medicaid presuppose that differential access to high quality physicians is a key challenge for beneficiaries." However, certain low-value services did occur more frequently depending on insurance status. For instance, uninsured or Medicare-insured patients were more likely to be inappropriately prescribed a narcotic than privately insured patients were. Additionally, while rates of low-value care were not significantly different, privately insured patients received high-value care at a higher rate than uninsured or those insured by Medicaid. "These results show that in addition to improving underuse of high-value care, overuse of low-value care is a potentially important focus for state Medicaid programs and safety-net institutions to pursue," the authors said.

HRC Recommends: Risk managers' awareness and support of quality-of-care data collection and reporting is critical because the goals of quality improvement and risk management are congruent. Risk managers can support the organization's risk management, quality, and patient safety activities by providing essential information on risk and quality performance so that the organization's reliability in execution of select practices can be viewed against industry standards.