Using United States medicare program claims to identify reliable measures of low value services influenced by primary care physician decisions.

backgroundLow-value services (LVS) are those that "… provide little to no benefit to patients…."

methodsRetrospective observational cohort study to identify which of a 31-item LVS measure set were most commonly performed, ordered, or referred by PCPs and examine the reliability of subsets of PCA-LVS measures. Setting was primary care practices in the Comprehensive Primary Care Plus (CPC+) model evaluation. 5,741,061 Medicare fee-for-service (FFS) beneficiaries attributed to 11,910 practices and 40,981 physicians in 2018 were observed. Based on percentages of LVS commonly performed, ordered, or referred by PCPs, we defined a 4-item and an 11-item PCA-LVS measure. We compared the reliability of the 4-item, 11-item, and 31-item LVS measure sets using Spearman ρ (rho) rank-order correlation and the Intra-Class correlation coefficient (ICC). Limitations included that PCP performing, ordering, and referring data are not available in all claims. Claims-based analyses of diagnosis codes may misclassify some appropriate services as PCA-LVS.

resultsThe 4-item PCA-LVS measure has a significantly higher mean reliability estimate than the original 31-item measure in identifying PCPs who provide low versus high rates of LVS. The 11-item PCA-LVS measure also had significantly higher reliability than the 31-item measure but lower reliability than the 4-item measure.

conclusionsWe identified two LVS subsets reflecting LVS events most influenced by PCPs. Further work will be required to ascertain how best to use this or related PCA-LVS measures to enhance the quality of primary care.