Schwartz AL, et al. - Via conducting an observational study using the Medicare claims data of 3,159,834 beneficiaries served by 41,773 generalist physicians, researchers determined variation in provision of low-value healthcare services among primary care physicians and estimated the proportion of variation attributable to physician characteristics that may be used to predict performance. According to findings, there may be a substantial contribution of physician practices to low-value service use, which is prevalent even among the least wasteful physicians. Given a little variation in prediction by measured physician characteristics, direct measures of low-value care provision may aid organizational efforts to encourage high-value practices.

Methods

• Researchers included national Medicare fee-for-service claims of beneficiaries served by generalist physicians from January 1, 2008, through December 31, 2013 (data were analyzed in 2016 through 2018) in this retrospective analysis.
• They estimated the extent of variation in service use across physicians within their region and provider organization using multilevel modeling, adjusted for patient clinical and sociodemographic characteristics and sampling variation.
• Additional regression analysis were done to determine the proportion of variation attributable to physician characteristics that may be used to predict performance (age, sex, academic degree, professorship, publication record, trial investigation, grant receipt, pharmaceutical or device manufacturer payment, and panel size).
• Annual count per beneficiary of 17 primary care–associated services that provide minimal clinical benefit was assessed as the main outcome.

Results

• Researchers observed the mean annual rate of low-value services of 33.1 services per 100 beneficiaries among the 3,159,834 beneficiaries (58.3% women; mean [SD] age, 73.2 [11.0] years) served by 41,773 physicians (74.9% men; mean [SD] age, 48.0 [10.1] years).
• Physicians within the same region showed considerable variation (SD, 8.8 [95% CI, 8.7-8.9]; 90th:10th percentile ratio, 2.03 [95% CI, 2.01-2.06]) and across physicians within the same organization (SD, 6.1 [95% CI, 6.0-6.2]; 90th:10th percentile ratio, 1.61 [95% CI, 1.60-1.63]).
• At the 10th percentile of physicians within region and within organization, respectively, they observed corresponding rates of 21.8 and 25.3 services per 100 beneficiaries.
• Only 4.4% of physician variation within region and 1.4% of physician variation within organization were seemed related to observable physician characteristics.