MedPAC mulls plan to stop covering some 'low value' procedures

MedPAC Chairman Glenn Hackbarth
MedPAC Chairman Glenn Hackbarth

Congress' advisory panel for Medicare payment policy is considering a plan that would stop covering certain “low-value” procedures and tests because their return on investment isn't good enough. Such procedures are costing the program nearly $6 billion a year while yielding little benefit, panel members noted — the latest in a series of developments driving value-based purchasing across the continuum of care.

The Medicare Payment Advisory Commission explored the results of a 2012 analysis that found $5.8 billion in claims were paid that year for so-called “low value” services such as a prostate-specific antigen test for prostate cancer. In lieu of eliminating coverage, MedPAC commissioners might consider charging beneficiaries more for low-value services, according to reports coming out of Thursday's MedPAC meeting.

MedPAC Chairman Glenn Hackbarth said he believes those payments subtract from the availability of public resources for high-value services and “appropriate subsidies” for low-income people. Ariel Winter, a MedPAC principal policy analyst, added that low-value care can actually harm patients by exposing them “to the risk of injury from the service itself and indirectly when the initial service leads to a cascade of additional tests and procedures that contain risks but provide little or no benefit.”

By adopting narrower acceptable claims diagnoses for certain kinds of mostly outpatient services, the program would save close to $2 billion a year, according to MedPAC staff.

Editor's note: This story has been updated from its original version.