Three services categorized as “low-value care” or “care that has little or no clinical benefit” drained hundreds of millions of dollars from Medicare from 2011-2016, according to a report from the Medicare Payment Advisory Commission (MedPAC).
The three services highlighted in the report are: early dialysis for people with functional kidneys, proton beam centers, and H.P. Acthar Gel.
Medicare spent from $500 million to $1.4 billion in 2016 alone on early-stage kidney dialysis that “is not associated with improved outcomes.” (RELATED: More Insurers Are Entering The Individual Insurance Market In 2019)
During that same year, Medicare spent $115 million on proton beam therapy, an external, targeted cancer treatment, that has “a lack of evidence that it offers a clinical advantage over alternative treatments” despite being “substantially” more expensive.
Medicare spending on Acthar went from $49 million to $504 million between 2011 to 2015. Acthar gel, which can be used to treat Multiple Sclerosis symptoms, has “weak evidence” of being an effective treatment. In addition to questions about its efficacy, 71 percent of physicians received payments from the manufacturer not related to research.
The report suggests tying effectiveness to coverage and payment under Medicare. Currently, “Medicare’s coverage process considers, but does not require, comparative clinical effectiveness evidence” when deciding which treatments to cover.
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