title: Low-Value Service Use in Provider Organizations.
abstract: To assess whether provider organizations exhibit distinct profiles of low-value service provision.
  
  
  
  2007-2011 Medicare fee-for-service claims and enrollment data.
  
  
  
  Use of 31 services that provide minimal clinical benefit was measured for 4,039,733 beneficiaries served by 3,137 provider organizations. Variation across organizations, persistence within organizations over time, and correlations in use of different types of low-value services within organizations were estimated via multilevel modeling, with adjustment for beneficiary sociodemographic and clinical characteristics.
  
  
  
  Organizations provided 45.6 low-value services per 100 beneficiaries on average, with considerable variation across organizations (90th/10th percentile ratio, 1.78; 95 percent CI, 1.72-1.84), including substantial between-organization variation within hospital referral regions (90th/10th percentile ratio, 1.66; 95 percent CI, 1.60-1.71). Low-value service use within organizations was highly correlated over time (r, 0.98; 95 percent CI, 0.97-0.99) and positively correlated between 13 of 15 pairs of service categories (average r, 0.26; 95 percent CI, 0.24-0.28), with the greatest correlation between low-value imaging and low-value cardiovascular testing and procedures (r, 0.54).
  
  
  
  Use of low-value services in provider organizations exhibited substantial variation, high persistence, and modest consistency across service types. These findings are consistent with organizations shaping the practice patterns of affiliated physicians.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Schwartz
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Alan M
authors.identifier: 0000-0003-1072-6043
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.|Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.|Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: McWilliams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D020400:Provider-Sponsored Organizations / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D014481:United States
keywords: Low value; Medicare; efficiency; quality measurement