{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:14:00Z","timestamp":1788315240578,"version":"build-2803163510"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":75,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services","award":["contracts HHSM-500-2014-00034I\/75FCMC19F0005 and HHSM-500-2014-00034I\/HHSM-500-T0010."],"award-info":[{"award-number":["contracts HHSM-500-2014-00034I\/75FCMC19F0005 and HHSM-500-2014-00034I\/HHSM-500-T0010."]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"DOI":"10.1186\/s12913-026-14983-4","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:45:10Z","timestamp":1781862310000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using United States medicare program claims to identify reliable measures of low value services influenced by primary care physician decisions"],"prefix":"10.1186","volume":"26","author":[{"given":"Chris","family":"Fleming","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitriy","family":"Poznyak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhea","family":"Powell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Erba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunhae","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Burkhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arkadipta","family":"Ghosh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4973-8607","authenticated-orcid":false,"given":"Eugene C.","family":"Rich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"9","key":"14983_CR1","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1007\/s11606-019-05069-5","volume":"34","author":"JK Maratt","year":"2019","unstructured":"Maratt JK, Kerr EA, Klamerus ML, et al. Measures used to assess the impact of interventions to reduce low-value care: A systematic review. J Gen Intern Med. 2019;34(9):1857\u201364.","journal-title":"J Gen Intern Med"},{"issue":"7","key":"14983_CR2","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1001\/jamainternmed.2014.1541","volume":"174","author":"AL Schwartz","year":"2014","unstructured":"Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring low-value care in Medicare. JAMA Intern Med. 2014;174(7):1067\u201376.","journal-title":"JAMA Intern Med"},{"issue":"1","key":"14983_CR3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1001\/jamainternmed.2018.5086","volume":"179","author":"AL Schwartz","year":"2019","unstructured":"Schwartz AL, Jena AB, Zaslavsky AM, McWilliams JM. Analysis of physician variation in provision of low-value services. JAMA Intern Med. 2019;179(1):16\u201325.","journal-title":"JAMA Intern Med"},{"issue":"13","key":"14983_CR4","doi-asserted-by":"publisher","first-page":"3453","DOI":"10.1007\/s11606-022-07654-7","volume":"37","author":"C Fleming","year":"2022","unstructured":"Fleming C, Shin E, Powell R, et al. Updating a claims-based measure of low-value services applicable to Medicare Fee-for-Service Beneficiaries. J Gen Intern Med. 2022;37(13):3453\u201361.","journal-title":"J Gen Intern Med"},{"issue":"6","key":"14983_CR5","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1111\/1475-6773.14053","volume":"57","author":"E Shin","year":"2022","unstructured":"Shin E, Fleming C, Ghosh A, et al. Assessing patient, physician, and practice characteristics predicting the use of low-value services. Health Serv Res. 2022;57(6):1261\u201373.","journal-title":"Health Serv Res"},{"issue":"6","key":"14983_CR6","doi-asserted-by":"publisher","first-page":"875","DOI":"10.7326\/M20-6257","volume":"174","author":"A Baum","year":"2021","unstructured":"Baum A, Bazemore A, Peterson L, et al. Primary care physicians and spending on low-value care. Ann Intern Med. 2021;174(6):875\u20138.","journal-title":"Ann Intern Med"},{"key":"14983_CR7","volume-title":"Medicare Claims Processing Manual, Chap. 26 \u2013 Completing and Processing Form CMS-1500 Data Set","author":"Centers for Medicare & Medicaid Services","year":"2022","unstructured":"Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chap. 26 \u2013 Completing and Processing Form CMS-1500 Data Set. Baltimore, MD: CMS; 2022."},{"key":"14983_CR8","unstructured":"Research Data Assistance Center. Finding the CMS Data File You Need. Available at: https:\/\/resdac.org\/cms-data?tid_1%5B1%5D=1&tid%5B4931%5D=4931. Accessed November 2, 2022."},{"key":"14983_CR9","doi-asserted-by":"publisher","DOI":"10.1002\/9780470696750","volume-title":"Interpretation and Use of Medical Statistics","author":"LE Daly","year":"2000","unstructured":"Daly LE, Bourke GJ. Interpretation and Use of Medical Statistics. Oxford: Blackwell Science Ltd; 2000."},{"key":"14983_CR10","unstructured":"Kazis LE, Rogers W, Rothendler J, et al. Outcome performance measure development for persons with multiple chronic conditions. Available at: Accessed August 4, 2021. https:\/\/www.rand.org\/pubs\/research_reports\/RR1844.html. Accessed August 4, 2021."},{"key":"14983_CR11","volume-title":"Foundations of Clinical Research: Applications to Practice","author":"LG Portney","year":"2000","unstructured":"Portney LG, Watkins WP. Foundations of Clinical Research: Applications to Practice. New Jersey: Prentice Hall; 2000."},{"key":"14983_CR12","volume-title":"Draft Acceptable Reliability Thresholds","author":"National Quality Forum","year":"2021","unstructured":"National Quality Forum. Draft Acceptable Reliability Thresholds. Volume 4. Washington, DC: National Quality Forum; 2021."},{"key":"14983_CR13","unstructured":"Cohen J. Statistical power analysis for the behavioral sciences (2nd edition). Hillsdale, NJ: Lawrence Earlbaum Associates."},{"issue":"11","key":"14983_CR14","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1056\/NEJMsa0906323","volume":"362","author":"JL Adams","year":"2010","unstructured":"Adams JL, Mehrotra A, Thomas JW, McGlynn EA. Physician Cost Profiling \u2013 Risk of Misclassification. N Engl J Med. 2010;362(11):1014\u201321. https:\/\/doi.org\/10.1056\/NEJMsa0906323.","journal-title":"N Engl J Med"},{"issue":"4","key":"14983_CR15","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1111\/1475-6773.12561","volume":"52","author":"JL Adams","year":"2017","unstructured":"Adams JL, Paddock SM. Misclassification Risk of Tier-Based Physician Quality Performance Systems. Health Serv Res. 2017;52(4):1277\u201396. https:\/\/doi.org\/10.1111\/1475-6773.12561.","journal-title":"Health Serv Res"},{"issue":"17","key":"14983_CR16","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1001\/jama.2021.3308","volume":"325","author":"AH Oakes","year":"2021","unstructured":"Oakes AH, Radomski TR. Reducing Low-value care and improving health care value. JAMA. 2021;325(17):1715\u20136.","journal-title":"JAMA"},{"issue":"11","key":"14983_CR17","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1001\/jamainternmed.2021.5531","volume":"181","author":"I Ganguli","year":"2021","unstructured":"Ganguli I, Morden NE, Yang CW, et al. Low-value care at the actionable level of individual health systems. JAMA Intern Med. 2021;181(11):1490\u2013500.","journal-title":"JAMA Intern Med"},{"issue":"9","key":"14983_CR18","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1001\/jama.2022.14587","volume":"328","author":"DA O\u2019Connor","year":"2022","unstructured":"O\u2019Connor DA, Glasziou P, Maher CG, et al. Effect of an individualized audit and feedback intervention on rates of musculoskeletal diagnostic imaging requests by Australian general practitioners: A randomized clinical trial. JAMA. 2022;328(9):850\u201360.","journal-title":"JAMA"},{"issue":"9","key":"14983_CR19","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1001\/jama.2022.14173","volume":"328","author":"D Korenstein","year":"2022","unstructured":"Korenstein D, Gillespie EF. Audit and feedback\u2014Optimizing a strategy to reduce low-value care. JAMA. 2022;328(9):833\u20135.","journal-title":"JAMA"},{"issue":"5","key":"14983_CR20","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1177\/1077558716656970","volume":"74","author":"CH Colla","year":"2017","unstructured":"Colla CH, Mainor AJ, Hargreaves C, Sequist T, Morden N. Interventions aimed at reducing use of low-value health services: A systematic review. Med Care Res Rev. 2017;74(5):507\u201350.","journal-title":"Med Care Res Rev"},{"issue":"Suppl 2","key":"14983_CR21","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1111\/1475-6773.12413","volume":"50","author":"RA Berenson","year":"2015","unstructured":"Berenson RA, Rice T. Beyond measurement and reward: Methods of motivating quality improvement and accountability. Health Serv Res. 2015;50(Suppl 2):2155\u201386.","journal-title":"Health Serv Res"},{"issue":"2","key":"14983_CR22","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1097\/HMR.0000000000000197","volume":"44","author":"RM Machta","year":"2019","unstructured":"Machta RM, Maurer KA, Jones DJ, Furukawa MF, Rich EC. A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes. Health Care Manage Rev. 2019;44(2):159\u201373.","journal-title":"Health Care Manage Rev"},{"key":"14983_CR23","doi-asserted-by":"publisher","unstructured":"O\u2019Malley AS, Sarwar R, Alvarez C, Rich EC. Why primary care practitioners aren\u2019t joining value-based payment models: reasons and potential solutions. Commonwealth Fund. July 2024. https:\/\/doi.org\/10.26099\/2cxx-0z64.","DOI":"10.26099\/2cxx-0z64"},{"key":"14983_CR24","doi-asserted-by":"publisher","unstructured":"Contreary K, Chatrath S, Jones DJ, Cohen G, Miller D, Rich EC. Consolidation and mergers among health systems in 2021: new data from the AHRQ compendium. Health Affairs. June 2023;20. https:\/\/doi.org\/10.1377\/forefront.20230614.519366.","DOI":"10.1377\/forefront.20230614.519366"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-026-14983-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-14983-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-14983-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:18:57Z","timestamp":1788311937000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12913-026-14983-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["14983"],"URL":"https:\/\/doi.org\/10.1186\/s12913-026-14983-4","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"12 June 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The need for informed consent was waived per the New England Institutional Review Board (IRB), which granted the CPC+ evaluation an IRB exemption on the basis of the federal common rule (Sect.\u00a0 45 CFR 46.101[b][5]), because the purpose of the study was to evaluate a public benefit program.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate <b>(IRB approval)<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Authors\u2019 information","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.","order":4,"name":"Ethics","label":"Disclaimer","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1223"}}