The United States federal government’s Medicare programme, in partnership with older adults who share some out-of-pocket costs, currently spends an estimated $4.4 billion each year on medical services that provide little to no clinical benefit. A new study suggests that this spending not only fails to improve health outcomes but may also put patients at greater risk of harm. The analysis highlights a set of tests, scans, and procedures that are widely used despite strong evidence questioning their effectiveness.
The researchers focused on 47 services that prior studies have identified as low-value, meaning they rarely improve patient wellbeing in the populations to which they are often applied. They argue that reducing or eliminating the use of such interventions in patients who are unlikely to benefit would preserve scarce Medicare resources for treatments with real impact. By adopting a more targeted approach, policymakers could simultaneously protect patients and improve the efficiency of healthcare spending.
Among these services, five stand out for their outsized cost and lack of clinical justification. Concentrating reform efforts on these alone could save $2.6 billion annually for Medicare and its enrollees. All five have received a “D” rating from the U.S. Preventive Services Task Force (USPSTF), meaning the evidence shows they are either ineffective or pose greater risks than benefits. Crucially, under the Affordable Care Act, such a rating gives the Secretary of Health and Human Services the authority to withhold Medicare payment for these services.
The five procedures singled out are illustrative of the problem. They include screening all older adults for chronic obstructive pulmonary disease, testing symptom-free patients for bacteria in the urine, and prostate-specific antigen (PSA) screening in men over 70 with no relevant history. Also on the list are screening older adults with no symptoms for blockages in the carotid arteries and the use of electrocardiograms in those without any signs of heart rhythm disturbances. Each has become routine in some practices, yet the evidence shows that, in the absence of specific risk factors or symptoms, they provide no meaningful benefit.
Beyond these five, the study catalogues 42 additional services judged low-value by professional societies and research organisations. Seventeen of these, combined with three of the USPSTF “D” rated interventions, accounted for an astonishing 94% of all the low-value care identified in the study. This concentration underscores the potential of focusing on a relatively small number of procedures to make significant progress in reducing wasteful spending.
The work was led by health economist David D. Kim of the University of Chicago and primary care physician A. Mark Fendrick of the University of Michigan Medical School’s Center for Value-Based Insurance Design. Their study, published in JAMA Health Forum, aligns with ongoing federal initiatives to control the rising costs of Medicare. Kim noted that while some patients may still benefit from these services under specific circumstances, avoiding them in those who cannot benefit would yield substantial savings. He also emphasised that his team did not include downstream costs caused by low-value interventions, such as the unnecessary follow-up procedures triggered by PSA screening. In that case, every $1 spent on screening can generate an additional $6 in subsequent, often needless care.
Fendrick highlighted that the study took a nuanced, evidence-driven approach rather than a blunt cost-cutting one. By carefully distinguishing between patient groups who could or could not benefit from these services, the researchers relied on objective clinical data rather than general assumptions. They examined anonymised Medicare claims from 2018 to 2020 and then extrapolated their findings to the broader Medicare population. “This research is highly policy relevant,” he explained, “because it offers a patient-focused framework for identifying unnecessary spending without compromising quality of care.” He added that the Affordable Care Act’s provisions for excluding USPSTF “D” rated services from coverage are an example of value-based insurance design at work, ensuring resources are directed towards care that truly improves health outcomes.
More information: David D. Kim et al, Projected Savings From Reducing Low-Value Services in Medicare, JAMA Health Forum. DOI: 10.1001/jamahealthforum.2025.3050
Journal information: JAMA Health Forum Provided by Michigan Medicine – University of Michigan