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Who's Accountable? Low-Value Care Received By Medicare Beneficiaries Outside Of Their Attributed Health Systems.
- Source :
-
Health affairs (Project Hope) [Health Aff (Millwood)] 2023 Aug; Vol. 42 (8), pp. 1128-1139. - Publication Year :
- 2023
-
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-three percent of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38 percent from specialists, 4 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.
Details
- Language :
- English
- ISSN :
- 2694-233X
- Volume :
- 42
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Health affairs (Project Hope)
- Publication Type :
- Academic Journal
- Accession number :
- 37549329
- Full Text :
- https://doi.org/10.1377/hlthaff.2022.01319