Overuse or low-value care is the delivery of tests and procedures that provide little clinical benefit, increase health care spending without improving health outcomes, or risk patient harm in excess of potential benefits.

2 Our objective was to estimate the inpatient adverse events (and their additional costs) to Medicare beneficiaries who likely received a low-value procedure.

Whereas the volume and financial costs are one concerning aspect of low-value care, another aspect is the resulting physical harms, which may be unnecessary if the care was avoidable. Numerous studies have estimated the prevalence of low-value care using claims data. 1 Ideally, the benefits of treatment outweigh this risk, but this may not be the case for patients receiving low-value care. The World Health Organization estimates that 1 in 10 patients in high-income countries are harmed while receiving hospital care. A total of 17 HACs and PSIs occurred in these admissions.Ĭonclusions and Relevance In this cross-sectional cohort study of Medicare fee-for-service claims, patients receiving potential low-value care were exposed to risk of unnecessary harm associated with higher cost and LOS. There were 419 509 included outpatient procedures, and 7514 (1.8%) had an unplanned admission within 7 days. Overall, HACs during a PCI admission were associated with the highest adjusted additional mean LOS (17.5 days 95% CI, 10.3-23.6), with also the highest adjusted additional mean cost ($22 000 95% CI, $9100-$32 600). Spinal fusion was associated with the most HACs (123 admissions) and PSIs (1015 admissions). Among the 197 755 claims for the inpatient procedures, 231 had an HAC and 1764 had a PSI. Results There were 573 351 patients included in the study, with 617 264 procedures the mean (SD) age was 74.2 (6.7) years, with 320 637 women (55.9%), and mostly White patients (520 735 90.8%). For outpatient procedures, we report the number of claims where the beneficiary had an unplanned hospital admission within seven days and the number of these admissions with a HAC/PSI. Main Outcomes and Measures For inpatient procedures, the number and rate of admissions with a hospital-acquired condition (HAC) or patient safety indicator event (PSIs), as well as the unadjusted and adjusted difference in mean LOS and Medicare costs between admissions with and without a HAC/PSI. Analysis was conducted from July to December, 2020. Procedures were selected if they had previously published indicators of low-value care, including knee arthroscopy, spinal fusion, vertebroplasty, percutaneous coronary intervention (PCI), carotid endarterectomy, renal stenting, and hysterectomy for benign conditions. Participants were aged 65 years or older. Objective To report the prevalence of adverse events associated with potential low-value procedures and the additional hospital length of stay (LOS) and costs.ĭesign, Setting, and Participants This is a retrospective cohort study using Medicare fee-for-service claims between January 2016 to December 2018. Importance There has been insufficient research on the patient harms and costs associated with potential low-value procedures in the US Medicare population. Shared Decision Making and Communication.

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