Wednesday, May 8, 2024
5/8/2024
Project Summary Low-value care (LVC), defined as care where harms or costs outweigh the benefits, is common and costly. For patients, LVC can result in physical harm from the service itself, unnecessary follow-up tests/procedures, and needless out-of-pocket costs. Patients with coronary artery disease (CAD) are at high risk of receiving LVC: studies estimate that up to 50% of tests and 15% of procedures performed on patients with CAD may be LVC. To identify and reduce LVC, accurate measurement is critical. Despite widespread adoption of administrative claims-based measures to assess LVC, most measures have not been tested against the “gold standard” of chart review (i.e., they do not have good criterion validity). Using inaccurate LVC measures undermines quality reporting and leads to inaccuracies in understanding the frequency, costs, and trends in use of LVC services; a critical knowledge gap in understanding which LVC services should be prioritized for reduction. Bundled payment models (BPMs), which pay organizations a fixed price for a 90-day episode of care such as elective percutaneous coronary intervention (PCI), could reduce LVC but could also have unintended consequences. Because BPMs provide a fixed payment to providers independent of patient risk, BPM providers might perform more PCIs on low-risk patients for whom medical therapy alone is the guideline- recommended treatment (i.e., they may perform more LVC PCIs). BPM providers might also perform fewer appropriate PCIs for high-risk patients, or those perceived to be high-risk such as racial/ethnic minorities. To assess the impacts of the elective PCI BPM, we will use data from the National Cardiovascular Data Registry, which contains a reliable measure to classify PCIs as LVC or appropriate using clinical chart review data. We have assembled an experienced team of cardiologists, economists, and outcomes researchers. In prior and pilot work we have validated 3 claims-based LVC measures, but also found that 1 measure was not valid. In Aim 1, we will use chart review as a “gold-standard” to assess the validity of commonly-used claims-based LVC measures relevant for CAD patients. In Aim 2, we will use validated LVC measures to assess LVC frequency, costs, and trends among a national sample of Medicare beneficiaries with CAD, and provide policymakers with a priority list of LVC services to target for reduction. In Aim 3, we will conduct a difference-in- differences analysis to assess the impact of elective PCI BPMs on a) LVC PCIs and healthcare disparities for appropriate PCIs using detailed clinical data from the NCDR, and b) other validated LVC services using linked Medicare claims. For patients with CAD, this research will 1) establish valid LVC measures which are needed for quality improvement and accountability programs, 2) guide efforts to reduce LVC services, and 3) evaluate the effect (and potential unintended consequences) of a policy intended to reduce LVC.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
