Evaluation of Payer Policies to Reduce Low-Value Medical Device–Based Procedure Use

What is the association of enacting evidence-based coverage policies for procedures that are often performed for low-value indications with utilization in a state Medicaid program?This quality improvement study used data from 1.5 million Louisiana Medicaid members to evaluate use of procedures identified as low-value (invasive coronary angiography and percutaneous coronary intervention for stable coronary artery disease, endovascular intervention for lower extremity peripheral arterial disease with intermittent claudication, and nasal sinus procedures for chronic rhinosinusitis). Enactment of evidence-based coverage policies was not associated with reductions in use of these procedures.These findings suggest that reduction of low-value procedure use in Medicaid requires a multipronged approach to address the multiple drivers of such care, in addition to the enactment of evidence-based coverage policies.

Corresponding Author: Sanket S. Dhruva, MD, MHS, San Francisco Veterans Affairs Medical Center, 4150 Clement St, 111C, San Francisco, CA 94121 (sanket.dhruva@ucsf.edu).

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