Research Article
Accountable CareWho’s Accountable? Low-Value Care Received By Medicare Beneficiaries Outside Of Their Attributed Health Systems
- Ishani Ganguli ([email protected]), Brigham and Women’s Hospital, Boston, Massachusetts.
- Maia L. Crawford, Dartmouth College, Lebanon, New Hampshire.
- Benjamin Usadi, Dartmouth College.
- Kathleen L. Mulligan, Brigham and Women’s Hospital.
- A. James O’Malley, Dartmouth College.
- Ching-Wen Wendy Yang, Dartmouth College.
- Elliott S. Fisher, Dartmouth College.
- Nancy E. Morden, UnitedHealthcare, Minnetonka, Minnesota.
Abstract
Policy makers and payers increasingly hold health systems accountable for spending and quality for their attributed beneficiaries. Low-value care—medical services that offer little or no benefit and have the potential for harm in specific clinical scenarios—received outside of these systems could threaten success on both fronts. Using national Medicare data for fee-for-service beneficiaries ages sixty-five and older and attributed to 595 US health systems, we describe where and from whom they received forty low-value services during 2017–18 and identify factors associated with out-of-system receipt. Forty-one percent of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 35 percent from specialists, 5 percent from primary care physicians, and 1 percent from advanced practice clinicians. Recipients of low-value care were more likely to obtain that care out of system if age 75 or older (versus ages 65–74), male (versus female), non-Hispanic White (versus other races or ethnicities), rural dwelling (versus metropolitan dwelling), more medically complex, or experiencing lower continuity of care. However, out-of-system service receipt was not associated with recipients’ health systems’ accountable care organization status. Health systems might improve quality and reduce spending for their attributed beneficiaries by addressing out-of-system receipt of low-value care—for example, by improving continuity.
