Effect of Health Service Area on Primary Care Physician Provision of Low-Value Cancer Screening | Annals of Internal Medicine
Background: Using a health systems approach to investigate low-value care (LVC) may provide insights into structural drivers of this pervasive problem. Objective: To evaluate the influence of service area practice patterns on low-value mammography and prostate-specific antigen (PSA) testing. Design: Retrospective study analyzing LVC rates between 2008 and 2018, leveraging physician relocation in 3-year intervals of matched physician and patient groups. Setting: U.S. Medicare claims data. Participants: 8254 physicians and 56 467 patients aged 75 years or older. Measurements: LVC rates for physicians staying in their original service area and those relocating to new areas. Results: Physicians relocating from higher-LVC areas to low-LVC areas were more likely to provide lower rates of LVC. For mammography, physicians staying in high-LVC areas (LVC rate, 10.1% [95% CI, 8.8% to 12.2%]) or medium-LVC areas (LVC rate, 10.3% [CI, 9.0% to 12.4%]) provided LVC at a higher rate than physicians re