Low Value Vitamin D Screening in Northern New England

Background: Low vitamin D levels in the general population are of concern to physicians and patients, although the causality between serum vitamin D and chronic disease has not been established, and the USPSTF graded vitamin D... [ view full abstract ]

Background: Low vitamin D levels in the general population are of concern to physicians and patients, although the causality between serum vitamin D and chronic disease has not been established, and the USPSTF graded vitamin D screening as indeterminate. We describe use of vitamin D screening between 2012-2014 in Maine.

Methods: We performed a population-based cross-sectional analysis of claims for vitamin D testing with an all-payer data set in 2012-2014 along with associated ICD-9 codes. We excluded patients who had the following diagnoses on their claims during the year they had a vitamin D test: kidney disease, osteoporosis, hypercalcemia, malabsorption, noninfectious enteritis and colitis, liver disease, pancreatic disease, gallbladder disease, gastric bypass surgery, or fractures.

Results: Among 816,740 adults in the dataset from 2012-2014 with no medical indication for testing, 147,479 (18.1%) had at least one vitamin D test, and 36.5% had more than one test over the three years. Testing with no indication decreased slightly from 2012 (12.4%) to 2013 (11.0%) to 2014 (9.7%). Testing occurred in similar proportions across all age groups and was highest in the 55-64 year old group. Over 30% of testing had associated diagnosis codes indicating the test was done for ill-defined symptoms such as malaise and fatigue. Based on Medicare reimbursement of $40.40 per test in 2014, we estimate that nearly $9,596,000 was spent during this interval on vitamin D testing without an appropriate medical indication.

Conclusion: Efforts to reduce unnecessary care should continue to target low-value testing, and both providers and patients should be made aware of lack of recommendations regarding vitamin D screening in asymptomatic adults. Denial of reimbursement for testing that is not medically indicated may further reduce testing.