JAMA Internal Medicine (07/13/26) Vandergrift, Jonathan L.; Landon, Bruce E.; Weng, Weifeng; et al.

A cross-sectional study of general internists participating in the American Board of Internal Medicine's Longitudinal Knowledge Assessment (LKA) and caring for Medicare fee-for-service beneficiaries aged 67 years or older found that higher first-year LKA scores were associated with lower use of low-value services (LVSs). The study included 7,089 general internists who cared for 898,365 Medicare fee-for-service beneficiaries. Overall, 30% of patients received at least one of 25 measured LVSs, but patients whose physicians were in the top LKA score quartile had a 28.6% adjusted likelihood of receiving any LVS compared with 31.0% for those whose physicians were in the bottom quartile, representing a 7.9% relative reduction and a 2.5 percentage-point absolute difference. Lower LVS use among patients of higher-scoring physicians was also observed across diagnostic and preventive testing, cancer screening, and imaging services. The largest differences were seen for thyroid hormone testing in patients with hypothyroidism and prostate-specific antigen testing in men aged 75 years or older. These findings suggest that better physician clinical knowledge, as measured by LKA performance, is associated with lower use of low-value services among Medicare beneficiaries.

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