Overuse in US Medicare during the COVID-19 pandemic: 2020 versus 2019

Abstract

BackgroundThe COVID-19 pandemic and March 2020 shutdown in the US reduced the volume of healthcare services, but the impact on overuse has not been investigated.ObjectiveTo examine the change in overuse rates and volumes through 2020.DesignA retrospective cohort study using Medicare fee-for-service claims.SettingOutpatient and inpatient claims.ParticipantsPatients who met the criteria for one of 10 overuse measures with a claim between January 1 2019 to December 31 2020.MeasurementsOveruse volumes were reported as patients with claims meeting overuse metric criteria per 100,000 Medicare beneficiaries. Overuse rates were measured by the same overuse cohort per 100 patients meeting the denominator criteria of the metric. Rates in 2020 were compared to the same date period in 2019 using incidence rate ratios (IRRs) estimated from Poisson regressions.ResultsIn 2019, 302,379 patients had an overuse claim (14.72% of 2,053,792 patients in the cohort) versus 234,481 (13.79% of 1,699,807) in 2020. The overall cohort included 2,112,904 (61.0%) women and a mean (SD) age of 76.5 (8.1) years. There was a 52.3% decrease in overall cohort volume during the COVID-19 shutdown; 2,341,017 patients in 2020 versus 4,912,453 in 2019. There was a 72.57% decrease in patients with an overuse procedure between April 2019 (N = 11,794) and 2020 (N = 3,220) (IRR 0.27 (95% CI 0.25 to 0.3; p <0.001)), including spinal fusion/laminectomy, carotid endarterectomy, knee arthroscopy, hysterectomy and vertebroplasty.LimitationsThis study uses claim-based measures of overuse and is limited to the first ten months of the COVID-19 pandemic.ConclusionsThe shutdown period during March through May in 2020 had a drastic impact on both the overuse volume and rates for these 10 overuse metrics.