088 Evaluation of payer policies to reduce low-value medical device-based procedure use

Objectives Low-value care is care where harms or costs exceed benefits. Much spending on low-value care is driven by highly reimbursed medical device-based procedures even when there are equally effective medical management available. Examples of low-value procedures include invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) for stable coronary artery disease; endovascular intervention for lower extremity peripheral arterial disease with intermittent claudication; and both nasal endoscopy with balloon ostial dilation and functional endoscopic sinus surgeries (collectively, sinus procedures) for chronic rhinosinusitis. We sought to evaluate the effect of evidence-based clinical coverage policies for these procedures in Louisiana’s Medicaid program.Method Louisiana Medicaid partnered with academic investigators to develop and enact policies between December 2021 and February 2022 to reduce the use of these procedures. We used an interrupted time series approach to evaluate utilization of these procedures in Louisiana Medicaid 12 months before and 18 months after policy enactment. Colonoscopy, a procedure where no new policies were implemented, served as a comparator.Monthly outpatient procedural utilization per 100,000 beneficiaries. For each procedure we constructed best-fit curves of pre-policy utilization trends, used these to generate predicted post-policy trends and compared them to actual observed post-policy utilization. We used 3-way time by intervention period by procedure analysis to assess the relative changes in utilization slope for each procedure as compared to colonoscopy.Results Differences in monthly outpatient procedure rate trends in the post-implementation compared to the pre-implementation period per 100,000 beneficiaries were as follows: ICA (0.65, 95% confidence interval [CI] 0.06–1.23), PCI (0.15, 95% CI -0.01–0.31), endovascular intervention (-0.01, 95% CI -0.12–0.10), and sinus procedures (-0.23, 95% CI -1.61–1.15). There was no significant change in the 3-way time by intervention period by procedure versus colonoscopy for any procedure, indicating a lack of statistically significant differences between the slope change for each of the four procedures compared to colonoscopy.Conclusions Implementation of evidence-based clinical coverage policies for four common medical device-based procedures was not associated with a reduction in procedure use in Louisiana Medicaid. There is a need to develop strategies to improve evidence-based care through multi-pronged efforts that include policymaking, policy implementation, and other methods.