This survey study estimates the national frequency and consequences of cascades of care after incidental findings using results from a national survey of US physicians.

IMPORTANCE Low-value care is prevalent in the United States, yet little is known about the downstream health care use triggered by low-value services. Measurement of such care cascades is essential to understanding the full consequences of low-value care.OBJECTIVE To describe cascades (tests, treatments, visits, hospitalizations, and new diagnoses) after a common low-value service, preoperative electrocardiogram (EKG) for patients undergoing cataract surgery. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study using fee-for-service Medicare claims data from beneficiaries aged 66 years or older without known heart disease who were continuously enrolled between

Key Points Question What characteristics are associated with the online portal–based scheduling of medical visits? Findings In this cross-sectional study of 62 080 patients and 134 225 completed visits at 17 primary care practices within a large academic medical center, early adopters of direct scheduling were more often young, White, and commercially insured. Compared with visits scheduled by speaking with clinic staff in person or by telephone, directly scheduled visits were more likely to be with one’s own primary care physician. Meaning These findings suggest that direct scheduling may contribute to primary care continuity and that if greater adoption by younger, White, commercially insured patients persists, this service may widen socioeconomic disparities in primary care access.

Key Points Question What are the prevalence of low-value testing during Medicare annual wellness visits and of cascades of medical services and new diagnoses that might follow? Findings In this cohort study of 75 275 fee-for-service Medicare beneficiaries aged 66 and older who received an annual wellness visit, 19% of beneficiaries received at least 1 routine electrocardiogram, urinalysis, or thyrotropin test during their visit, more often those who were younger and lived in urban, high-income areas. An estimated 6 cascade-attributable events per 100 electrocardiogram recipients and 5 events per 100 urinalysis recipients occurred in the subsequent 90 days. Meaning In this study, a minority of healthy Medicare beneficiaries received routine tests during their annual wellness visits, and low-value electrocardiograms and urinalyses were associated with cascades of care.

Accountable Care Organizations (ACOs) are provider groups that coordinate to provide high-quality care within a spending target for a defined patient population. While ACO leaders have focused care coordination and cost reduction efforts on primary care, 1-4 specialty care is a major and rising source of ACO spending growth that remains under-examined. 5-13 In theory, ACOs may address specialty cost growth by attempting to limit leakage to specialists outside of their organization 14 while encouraging efficient care among specialists within the organization, for example, through sharing performance data with specialists or offering them financial incentives to reduce spending. However, we know little about if or how ACOs are engaging specialists, and whether these efforts are associated with