Study – Medicare Pays Billions for Wasteful Care

A recent study indicates that 42 percent of 2009 Medicare patients received procedures providing little if any medical benefit and that it cost the Centers for Medicare & Medicaid Services (CMS) program $8.5 billion.

The study, published in JAMA Internal Medicine and reported by Reuters, is the first large-scale analysis of what the federal program spends on 26 procedures widely viewed as unnecessary. These include arthroscopic surgery for knee arthritis, advanced imaging for low back pain, and stents for patients with stable heart disease. Other procedures include preoperative X-rays and stress testing.

The study indicates at least one in four Medicare patients received unnecessary procedures. Co-author Aaron Schwartz said, “Low-value services are not harmless. They expose patient to radiation and surgery.”

Part of a growing body of work on evidence-based medicine where scrutiny is applied to common procedures, the study adds to concern over over-utilization by physicians. Why physicians pursue these tests and procedures is complicated. Some consider them standard of care while others are practicing defensive medicine, performing a test to avoid being sued if something is missed.

Brad Ericson

Brad Ericson

Director of Publishing at AAPC
Brad Ericson, MPC, CPC, COSC, has been director of publishing for more than 10 years. Before AAPC he was at Optum for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

About Has 292 Posts

Brad Ericson, MPC, CPC, COSC, has been director of publishing for more than 10 years. Before AAPC he was at Optum for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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