Article Figures & Data
Figures
- Figure 1.
The Primary Care Physician Sample Distribution of per-patient Low Value Care Medicare Spending ($).
- Figure 2.
Association between Physician Characteristics and per-patient Low Value Care Medicare Spending ($).
- Appendix Figure 1:
Sensitivity Analysis for OLS Regression Results using per-patient Low Value Care Medicare Allowed Charges ($) as Outcome.
- Appendix Figure 2:
Sensitivity Analysis for OLS Regression Results using Logarithm of Per-Patient Low Value Care Medicare Spending as Outcome.
- Appendix Figure 3:
Sensitivity Analysis for OLS Regression Results—Association between Physician Characteristics and Per-Patient LVC Spending ($) by Place of Service.
- Appendix Figure 4:
Robustness Check for Logistic Regression Results with Respect to Changes in Thresholds for Identifying High LVC Spending Group.
Tables
- Table 1.
Comparison of Characteristics between Low and High Low Value Care Spending Groups Among Primary Care
Characteristic All Low LVC Spending Group High LVC Spending Group p value (SD) (SD) (SD) LVC spending per patient ($) 14.67 (9.72) 10.11 (4.90) 26.83 (8.86) <.001 Total Medicare spending per patient ($)* 3,101 (1439.72) 2,877 (1375.63) 3,698 (1436.51) <.001 PCP Characteristics Age (mean) 51.0 (9.19) 50.9 (9.29) 51.2 (8.92) .309 Allopath 0.88 0.89 0.86 .057 Female 0.27 0.29 0.23 <.001 Non-US Medical Graduate 0.22 0.21 0.26 <.01 Patient size 159 (142.00) 147 (130.54) 189 (164.94) <.001 <50 0.22 0.23 0.18 <.01 50 to 149 0.37 0.38 0.33 <.01 150 to 299 0.28 0.28 0.30 .296 300+ 0.13 0.11 0.19 <.001 Specialty Internal Medicine 0.48 0.44 0.58 <.001 Family Medicine 0.49 0.52 0.39 <.001 Other Specialty 0.04 0.04 0.03 .086 Graduation Year Pre-1980 0.25 0.25 0.25 .828 1980 to 1989 0.33 0.32 0.36 .081 1990 to 2000 0.36 0.36 0.35 .607 Post-2000 0.06 0.07 0.05 <.05 Practice Region Northeast 0.19 0.18 0.22 <.01 Midwest 0.27 0.33 0.12 <.001 South 0.36 0.33 0.47 <.001 West 0.17 0.17 0.19 .193 Rural 0.16 0.20 0.06 <.001 Patient Panel Characteristics Age (mean) 76.70 (2.59) 76.97 (2.74) 76.00 (1.97) 65 to 69 0.22 0.21 0.24 <.001 70 to 74 0.24 0.24 0.26 <.001 75 to 79 0.19 0.19 0.20 <.001 80 to 84 0.16 0.16 0.16 <.05 85+ 0.19 0.20 0.15 <.001 Female 0.59 0.60 0.57 <.001 Race/Ethnicity White 0.89 0.89 0.89 .361 Black 0.07 0.07 0.07 .949 Other 0.04 0.03 0.04 .082 ElixHauser Comorbidity Index 0 0.13 0.14 0.11 <.001 1 to 2 0.50 0.51 0.47 <.001 3 to 5 0.30 0.29 0.34 <.001 6+ 0.07 0.06 0.08 <.001 Physician Practice Location Characteristics <12 years schooling 0.12 0.12 0.12 .832 Black 0.11 0.11 0.12 .059 Hispanic 0.11 0.10 0.15 <.001 <200% FPL 0.33 0.33 0.31 <.001 Number of Observations 6,873 5,499 1,374 LVC, low value care; FPL, federal poverty line; PCP, primary care physician; SD, standard deviation.
Choosing Wisely Initiative Prevalence Rate (%) No. of Qualifying Beneficiaries No. of LVC Beneficiaries No. of LVC Events Medicare Noninstitutional Part B Spending ($) Don't image low back pain in 1st 6 weeks 14.0 291,081 40,753 47,357 3,579,867 Don't get brain imaging for simple syncope 7.8 60,082 4,715 4,938 250,951 Don't DEXA screen for osteoporosis in men younger than 70 0.8 120,916 911 916 48,850 Don't get cardiac screening for low risk, asymptomatic patients 3.0 1,078,840 32,671 33,860 373,649 Don't routinely screen for prostate cancer 36.3 454,807 164,872 213,841 5,599,381 Don't perform routine pre-op testing before low risk surgical procedures 3.1 153,020 4,738 4,898 49,463 Don't screen for carotid artery disease in asymptomatic adult 2.6 1,078,840 28,053 30,986 2,808,962 Don't screen cervical cancer for women older than 65 8.6 624,044 53,461 54,653 2,386,114 LVC, low value care.
↵* Total number of Medicare beneficiaries in the study sample was 1,078,840. For each Choosing Wisely Initiative, qualifying beneficiaries indicated those Medicare beneficiaries who satisfied the qualifying criteria, as specified in Appendix Table 1, to receive the low value care service. The prevalence rate is a share (%) of qualifying beneficiaries who had received the specified low value care service. As in Schwartz et al.12, for each LVC service type, multiple LVC services that occurred the same day were considered one event.
- Appendix Table 2:
Association between Primary Care Physician Characteristics and Low Value Care Spending of Attributed Medicare Patients
Characteristic Panel A: OLS Estimates Panel B: Logit Odds Ratios Physician Characteristics Allopath −1.604† 0.461 0.655† 0.088 Female −0.570 0.453 1.012 0.149 Non-US Medical Graduate −0.232 0.415 0.985 0.113 Patient Size <50 −4.121‡ 0.572 0.323‡ 0.053 50 to 149 −2.775‡ 0.468 0.417‡ 0.056 150 to 299 −1.809‡ 0.417 0.542‡ 0.070 300+ Reference Reference Specialty Internal Medicine Reference Reference Family Medicine −1.063† 0.318 0.702‡ 0.067 Other Specialty −1.057 0.654 0.818 0.193 Graduation Year Pre-1980 Reference Reference 1980 to 1989 −0.161 0.383 1.090 0.124 1990 to 2000 −0.730 0.409 0.973 0.112 Post-2000 −1.564* 0.634 0.720 0.159 Practice Region Northeast Reference Reference Midwest −2.765‡ 0.456 0.407‡ 0.060 South 0.330 0.487 1.059 0.136 West 0.028 0.573 0.998 0.153 Rural −1.715‡ 0.331 0.522‡ 0.080 Patient Characteristics Age (years) 65 to 69 Reference Reference 70 to 74 −0.035 0.040 0.995 0.010 75 to 79 −0.063 0.035 0.989 0.010 80 to 84 −0.129‡ 0.034 0.983 0.010 85+ −0.334‡ 0.025 0.923‡ 0.007 Female −0.042† 0.015 0.984† 0.005 Race/Ethnicity White Reference Reference Black −0.067‡ 0.012 0.985‡ 0.004 Other −0.038 0.020 0.991 0.005 ElixHauser Comorbidity Index 0 Reference Reference 1 to 2 0.050* 0.024 1.015 0.009 3 to 5 0.213‡ 0.031 1.058‡ 0.007 6+ 0.307‡ 0.088 1.049‡ 0.011 Practice Location Characteristics <12 years schooling −0.097† 0.034 0.978* 0.011 Black 0.052‡ 0.012 1.015‡ 0.004 Hispanic 0.104‡ 0.016 1.028‡ 0.004 <200% FPL −0.077‡ 0.015 0.979‡ 0.005 Number of Observations 6,905 FPL, federal poverty line; OLS, ordinary least squares. Note: The dependent variable for Panel A was per-patient low value care (LVC) Medicare spending in dollar amounts, while the OR ratios in Panel B were calculated from logit regression results, where the dependent variable was equal to 1 if the primary care physician's (PCP's) per-patient LVC Medicare spending was in the top quintile. Both models were estimated using sample weights that reflect the oversampling of physicians in smaller states. For graphical representations of the estimates of PCP characteristics, see Figure 2 for Panel A and Figure 3 for Panel B.
↵* P < .05.
↵† P < .01.
↵‡ P < .001.
- Appendix Table 3:
Association between Practice Location Rurality and Low Value Care Spending of Attributed Medicare Patients Across Specialty
Characteristic Panel A: OLS Estimates Panel B: Logit Odds Ratio Estimates Coefficient SE OR SE Physician Characteristics Allopath −1.617‡ 0.4605 0.652† 0.0875 Female −0.566 0.4528 1.014 0.1500 Non-US Medical Graduate −0.216 0.4158 0.985 0.1138 Patient Size <50 −4.131‡ 0.5712 0.322‡ 0.0525 50 to 149 −2.779‡ 0.4675 0.416‡ 0.0560 150 to 299 −1.811‡ 0.4171 0.54‡ 0.0701 300+ Specialty Internal Medicine Family Medicine −1.182† 0.3499 0.68‡ 0.0687 Other Specialty −0.829 0.7742 0.84 0.2193 Graduation Year Pre-1980 1980 to 1989 −0.166 0.3834 1.090 0.1236 1990 to 2000 −0.741 0.4086 0.972 0.1122 Post-2000 −1.582* 0.6339 0.717 0.1578 Practice Region Northeast Midwest −2.752‡ 0.4570 0.408‡ 0.0606 South 0.339 0.4870 1.062 0.1369 West 0.03 0.5730 0.996 0.1529 Rural −2.152‡ 0.5269 0.43† 0.1104 RuralXSpecialty RuralXInternal Medicine RuralXFamily Medicine 0.764 0.5822 1.421 0.4270 RuralXOther Specialty −0.831 1.2300 0.922 0.5493 Patient Characteristics Age (years) 65 to 69 70 to 74 −0.037 0.0396 0.995 0.0105 75 to 79 −0.064 0.0345 0.989 0.0102 80 to 84 −0.131‡ 0.0338 0.983 0.0102 85+ −0.336‡ 0.0248 0.923‡ 0.0073 Female −0.042† 0.0154 0.984† 0.0049 Race/Ethnicity White Black −0.068‡ 0.0116 0.985‡ 0.0038 Other −0.038 0.0202 0.991 0.0050 ElixHauser Comorbidity Index 0 1 to 2 0.050* 0.0236 1.015 0.0085 3 to 5 0.214‡ 0.0307 1.058‡ 0.0074 6+ 0.307‡ 0.0877 1.049‡ 0.0107 Practice Location Characteristics <12 years schooling −0.096† 0.0336 0.978* 0.0105 Black 0.051‡ 0.0118 1.015‡ 0.0037 Hispanic 0.103‡ 0.0159 1.028‡ 0.0043 < 200% FPL −0.077‡ 0.0152 0.979‡ 0.0050 Number of Observations 6,905 OR, odds ratio; FLP, federal poverty line; OLS, ordinary least squares. Note: The dependent variable for Panel A was per-patient low value care (LVC) Medicare spending in dollar amounts, while the ORs in Panel B were calculated from logit regression results, where the dependent variable was equal to 1 if the primary care physician's (PCP) per-patient LVC Medicare spending was in the top quintile. RuralXSpecialty indicated a set of interaction terms between the rurality of PCP's practice location and PCP's specialty type. Practice was considered to be in a rural area if it was located in any of the six non-metropolitan county categories in the Rural Urban Continuum Code that divided all US counties into three metropolitan and six nonmetropolitan county categories. PCPs were categorized into three specialty types: those that practice internal medicine, family medicine, and other PCP specialties. Both models were estimated using sample weights that reflect the oversampling of physicians in smaller states.
↵* P < .05.
↵† P < .01.
↵‡ P < .001.
