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Looking at the link of payer type and low-value care

Researchers from The Dartmouth Institute for Health Policy and Clinical Practice examined the connection between payer type and low-value care to determine what effect that insurance design (commercial insurance vs. Medicare) may have on medical overuse and waste.

Among their findings:

  • “The tendency to deliver or avoid low-value care appears largely independent of payer type (Medicare or commercial) and patient population attributes. (Researchers note that the finding suggests that either the difference in anticipated reimbursement is unimportant to providers or that they are ‘unwilling or unable to discriminate by payer type at the point of care.’)
  • “Regions with a high specialist to primary care ratio have more overuse.
  • “Some Hospital Referral Regions may deliver more overuse either as a direct result of higher physician group competition or as an indirect result (more competition results in more fragmentation and redundancy).
  • “The use of the seven low-value services remained relatively consistent over time. However, Vitamin D screening increased substantially during the study period (perhaps as a result of increased public awareness and the promotion of Vitamin D deficiency as a medical concern). In contrast, the use of cervical cancer screening in the over 65 population decreased substantially.
  • “The rate of prescription of opioids for migraine patients is similar in both commercially insured and Medicare populations, but is much more commonly provided than the other Choosing Wisely services examined in the study. (The study’s authors note that study data may not reflect the slight decline in prescription opioid use in response to growing concerns over opioid abuse.)
  • “Finally, the study found that the use of low-value services in both payer types was greater among {groups with} higher proportions of black patients. The researchers note that their finding suggests a concerning ‘potential for double jeopardy in health services receipt among black Americans.’”

To read more, please hit this link.


Video and text: What is physicians’ role in opioid epidemic?


In this video in Med Page Today, F. Perry Wilson, M.D., looks at the data in an article in the journal Pain on physicians’ role in the opioid epidemic. He observes:

“Those who got opioids were more likely to have an antecedent history of opioid use disorder, substance use disorder, and a host of other psychiatric problems. They were also significantly more likely to have received psychotropic medications.

“So opioid prescriptions are going to some high-risk individuals. But how many of those would turn into chronic users?

“The study concludes – not that many. After 18 months, only 1.3% of individuals had transitioned from one-time to chronic use … at least based on prescription records.

“How do we think about that 1.3%? It may seem like a small percentage that isn’t worth worrying about, but multiply that by the number of prescriptions we’re handing out per year: about one for every person in the country.”

He concludes:

“In 2016, the CDC came down hard on opioid prescriptions for chronic conditions. This is the correct framework. Are docs responsible for the rise in opioid abuse and deaths in this country? Not exclusively. But we can’t deny that somewhere in the chain of events that leads to opioid abuse lies a prescription pad.”

To hear and read Dr. Wilson’s remarks, please hit this link.

To read the study in Pain, please hit this link.

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