{"doi":"10.1377/hlthaff.2022.01319","title":"Who’s Accountable? Low-Value Care Received By Medicare Beneficiaries Outside Of Their Attributed Health Systems","abstract":"Policy makers and payers increasingly hold health systems accountable for spending and quality for their attributed beneficiaries. Low-value care-medical services that offer little or no benefit and have the potential for harm in specific clinical scenarios-received outside of these systems could threaten success on both fronts. Using national Medicare data for fee-for-service beneficiaries ages sixty-five and older and attributed to 595 US health systems, we describe where and from whom they received forty low-value services during 2017-18 and identify factors associated with out-of-system receipt. Forty-three percent of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38 percent from specialists, 4 percent from primary care physicians, and 1 percent from advanced practice clinicians. Recipients of low-value care were more likely to obtain that care out of system if age 75 or older (versus ages 65-74), male (versus female), non-Hispanic White (versus other races or ethnicities), rural dwelling (versus metropolitan dwelling), more medically complex, or experiencing lower continuity of care. However, out-of-system service receipt was not associated with recipients' health systems' accountable care organization status. Health systems might improve quality and reduce spending for their attributed beneficiaries by addressing out-of-system receipt of low-value care-for example, by improving continuity.","journal":"Health Affairs","year":2023,"id":351526,"datarank":0.3453877639491069,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.0,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.948,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":754119,"name":"Maia L. Crawford","orcid":null,"position":1,"is_corresponding":false},{"id":1096209,"name":"Benjamin Usadi","orcid":"0000-0003-0879-3247","position":2,"is_corresponding":false},{"id":1096210,"name":"Kathleen L. Mulligan","orcid":"0000-0002-3696-0498","position":3,"is_corresponding":false},{"id":278523,"name":"A. James O’Malley","orcid":"0000-0001-8389-6217","position":4,"is_corresponding":false},{"id":1096537,"name":"Ching‐Wen Yang","orcid":null,"position":5,"is_corresponding":false},{"id":17361,"name":"Elliott S. Fisher","orcid":"0000-0002-9571-4879","position":6,"is_corresponding":false},{"id":824567,"name":"Nancy E. Morden","orcid":null,"position":7,"is_corresponding":false},{"id":225622,"name":"Ishani Ganguli","orcid":"0000-0002-3793-0995","position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:12:41.740237Z","pmid":"37549329","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}