An Index for Measuring Overuse of Health Care Resources With Medicare Claims

Segal, Jodi B; Nassery, Najlla; Chang, Hsien Yen; Chang, Eva; Chan, Kitty S.; Bridges, John F.P.

doi:10.1097/mlr.0000000000000304

Cited by 37 publications

(70 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…; Segal et al. ). Claims may not provide enough details of important disease (e.g., cancer) history or symptoms that clinically justified the screening, which would appear as low value in claims data.…”

Section: Resultsmentioning

confidence: 98%

“…; Segal et al. ). The Carrier and Outpatient claims files were searched to obtain the diagnoses (International Classification of Diseases, Ninth Revision [ICD‐9]) and procedures (the Health Care Financial Agency's common procedures coding system [HCPCS] codes & Current Procedural Terminology [CPT] codes) for billed tests, and the Medicare‐approved reimbursement amounts.…”

Section: Methodsmentioning

confidence: 98%

See 1 more Smart Citation

Socioeconomic Differences in Use of Low‐Value Cancer Screenings and Distributional Effects in Medicare

Jung

2016

Health Services Research

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 98%

Socioeconomic Differences in Use of Low‐Value Cancer Screenings and Distributional Effects in Medicare

Jung

2016

Health Services Research

View full text Add to dashboard Cite

show abstract

“…11, 12 To date, few studies have addressed methods to reduce overuse, and de-implementing non-beneficial practices has proven challenging. 1, 13, 14 Existing conceptual models for reducing overuse are theoretical 15 or focused at administrative decisions 16, 17 ; we believe a practical framework is needed. We used an iterative process, informed by expert opinion and discussion, to design such a framework.…”

Section: Introductionmentioning

confidence: 99%

A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient‐Clinician Interaction

Morgan

Leppin

Smith

et al. 2017

Journal of Hospital Medicine

View full text Add to dashboard Cite

The overuse of medical services is an increasingly recognized driver of poor quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. Other drivers of utilization influence this interaction and include health care system factors, the practice environment, the culture of professional medicine, the culture of health care consumption, and individual patient and clinician factors. The variable strength of evidence in support of these domains highlights important areas for further investigation.

show abstract

“…This definition is highly contiguous with definitions of overuse (Beckman 2011;Segal et al 2015) or overutilisation (Behnke et al 2013). Overuse (or overtreatment) thus represents an "error of commission" in which services with a poor benefit to risk profile are provided to patients (Chan et al 2013).…”

Section: Defining Overconsumption In Health Carementioning

confidence: 99%

“Too much medicine”: Insights and explanations from economic theory and research

Hensher

Tisdell

Zimitat

2017

Social Science & Medicine

View full text Add to dashboard Cite

2 "Too much medicine": insights and explanations from economic theory and research. AbstractIncreasing attention has been paid in recent years to the problem of "too much medicine", whereby patients receive unnecessary investigations and treatments providing them with little or no benefit, but which expose them to risks of harm. Despite this phenomenon potentially constituting an inefficient use of health care resources, it has received limited direct attention from health economists. This novel synthesis of economic perspectives suggests important scope for interdisciplinary collaboration; signals potentially important issues for health technology assessment and health technology management policies; and suggests that cultural change might be required to achieve significant shifts in clinical behaviour.

show abstract

An Index for Measuring Overuse of Health Care Resources With Medicare Claims

Abstract: This study confirms previous research hypothesizing that systematic regional variation in overuse exists and is measurable. Addition research is needed to validate index and to test its predictive and concurrent validity in panel data.

Cited by 37 publications

References 33 publications

Socioeconomic Differences in Use of Low‐Value Cancer Screenings and Distributional Effects in Medicare

Socioeconomic Differences in Use of Low‐Value Cancer Screenings and Distributional Effects in Medicare

A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient‐Clinician Interaction

“Too much medicine”: Insights and explanations from economic theory and research

Contact Info

Product

Resources

About