May 31, 2017
Minnesota patients spend millions for low-value medical tests and diagnostic imaging
The Minnesota Department of Health looked at 18 low-value medical tests and found Minnesota spent $54.9 million on them in 2014, even though they’re known to provide little benefit to patients.
Minnesota patients alone spent $9.3 million out-of-pocket for these services.
More than 450 types of low-value health care services have been identified nationally by consumer groups and medical societies, such as the American Board of Internal Medicine. These services and procedures provide little benefit to patients, and can potentially cause harm, due to radiation exposure for example. MDH, with assistance from researchers at Mayo Clinic, identified a subset of 18 of these low-value tests and imaging procedures to study in Minnesota.
“This research identifies a significant area of wasted resources and unnecessary exposure to potential patient harm,” said Health Commissioner Dr. Ed Ehlinger. “Providers and patients need to join together to avoid these tests that add needless expense to our overly expensive health care system.”
The research relied on the Minnesota All Payer Claims Database (MN APCD), a state repository of health care transactions for Minnesota patients derived from the billing records of medical providers. The analysis of health care claims found that in 2014 there were about 92,000 encounters associated with low-value diagnostic imaging and 83,000 encounters with low-value disease screening and testing. Diagnostic imaging for uncomplicated headaches was the most common and most costly low-value service observed, accounting for 40 percent of overall low-value cost.
“These are helpful numbers to have for the first time at a state level,” says Dr. Rod Christensen, vice president of medical operations at Allina Health. “They provide a benchmark for us to compare how well we are doing in our efforts to deliver high-value, high quality care consistently.”
The low-value services identified in the MDH study represent just a small subset of all medical interventions that may be low-value. In conducting this initial research, the MDH team focused on conditions and clinical circumstances where there is substantial consensus about them being low value. An important goal for clinicians and researchers is to continue to identify and eliminate unnecessary or duplicative care or care in the wrong setting for more complex conditions and circumstances.
Examples of low-value tests in this study include things like unwarranted imaging for people with low back pain or for uncomplicated headache. Low-value screens include cervical cancer screening for women younger than age 21 or older than 65, colorectal cancer screening for adults 85 and older, and prostate-specific antigen (PSA) tests for prostate cancer in men 75 and older.
Dr. Rozalina McCoy, an endocrinologist, primary care physician, and health services researcher from Mayo Clinic in Rochester, Minnesota, who assisted with identifying service types and interpreting the results of the analysis, notes, “reducing low-value services requires a culture change for patients and providers to recognize that ‘more’ isn’t always ‘better,’ when it comes to imaging and screening. In fact, many of these tests and procedures are not just ‘low value’ and therefore a poor use of health care resources, but they can cause real harm to patients who receive them.”
The issue brief can be accessed online at the MDH Health Economics Program website: Analysis of Low-Value Health Services in the Minnesota All Payer Claims Database (PDF)