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The U.S. spends huge amounts of money on health care that does little or nothing to help patients, and may even harm them. In Colorado, a new analysis shows that the number of tests and treatments conducted for which the risks and costs exceed the benefits has barely budged despite a decade-long attempt to tamp down on such care.

This story also ran on CBS News. It can be republished for free.

The state including the government, insurers, and patients themselves spent $134 million last year on what is called low-value care, according to the report by the Center for Improving Value in Health Care, a Denver nonprofit that collects billing data from health plans across Colorado. The top low-value items in terms of spending in each of the past three years were prescriptions for opiates, prescriptions for multiple antipsychotics, and screenings for vitamin D deficiency, according to the analysis.

Nationwide, those treatments raise costs, lead to health complications, and interfere with more appropriate care. But the structure of the U.S. health system, which rewards doctors for providing more care rather than the right care, has made it difficult to stop such waste. Even in places that have reduced or eliminated the financial incentive for additional testing, such as Los Angeles County, low-value care remains a problem.

And when patients are told by physicians or health plans that tests or treatments arent needed, they often question whether they are being denied care.

While some highly motivated clinicians have championed effective interventions at their own hospitals or clinics, those efforts have barely moved the needle on low-value care. Of the $3 trillion spent each year on health care in the U.S., 10% to 30% consists of this low-value care, according to multiple estimates.

Theres a culture of more is better, said Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design. And more is better is very hard to overcome. Email Sign-Up

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To conduct its study, the Center for Improving Value in Health Care used a calculator developed by Fendrick and others that quantifies spending for services identified as low-value care by the Choosing Wisely campaign, a collaborative effort of the American Board of Internal Medicine Foundation and now more than 80 medical specialty societies.

Fendrick said the $134 million tallied in the report represents just a small piece of the universe of no- and low-value care in Colorado. The calculator tracks only the 58 services that developers were most confident reflected low-value care and does not include the costs of the cascade of care that often follows. Every dollar spent on prostate cancer testing in men over 70, for example, results in $6 in follow-up tests and treatments, according to an analysis published in JAMA Network Open in 2022.

In 2013, Childrens Hospital Colorado learned it had the second-highest rate of CT abdominal scans a low-value service among U.S. childrens hospitals, with about 45% of kids coming to the emergency room with abdominal pain getting the imaging. Research had shown that those scans were not helpful in most cases and exposed the children to unnecessary radiation.

Digging into the problem, clinicians there found that if ER physicians could not find the appendix on an ultrasound, they swiftly ordered a CT scan.

New protocols implemented in 2016 have surgeons come to the ER to evaluate the patient before a CT scan is ordered. The surgeons and emergency doctors can then decide whether the child is at high risk of appendicitis and needs to be admitted, or at low risk and can be sent home. Within two years, the hospital cut its rate of CT scans on children with abdominal pain to 10%, with no increase in complications.

One of the hardest things to do in this work is to align financial incentives, said Lalit Bajaj, an emergency physician at Childrens Colorado who championed the effort, because in our health care system, we get paid for what we do.

Cutting CT scans meant less revenue. But Childrens Colorado worked with an insurance plan to create an incentive program. If the hospital could hold down the rate of high-cost imaging, saving the health plan money, it could earn a bonus from the insurer at the end of the year that would partly offset the lost revenue.

But Bajaj said its tough for doctors to deal with patient expectations for testing or treatment. Its not a great feeling for a parent to come in and I tell them how to support their child through the illness, Bajaj said. They dont really feel like they got testing done. Did they really evaluate my child? More from the Mountain States

That was a major hurdle in treating kids with bronchiolitis. That respiratory condition, most often caused by a virus, sends thousands of kids every winter to the ER at Childrens, where unneeded chest X-rays were often ordered.

The data was telling us that they really didnt provide any change in care, Bajaj said. What they did was add unnecessary expense.

Too often, doctors reading the X-rays mistakenly thought they saw a bacterial infection and prescribed antibiotics. They would also prescribe bronchodilators, like albuterol, they thought would help the kids breathe easier. But studies have shown those medicines dont relieve bronchiolitis.

Bajaj and his colleagues implemented new protocols in 2015 to educate parents on the condition, how to manage symptoms until kids get better, and why imaging or medication is unlikely to help.

These are hard concepts for folks, Bajaj said. Parents want to feel their child has been fully evaluated when they come to the ER, especially since they are often footing more of the bill.

The hospital reduced its X-ray rate from 40% in the 17 months before the new protocols to 29% in the 17 months after implementation, according to Bajaj. The use of bronchodilators dropped from 36% to 22%.

Part of the secret of Childrens success is that they brand their interventions. The hospitals quality improvement team gathers staff members from various disciplines to brainstorm ways to reduce low-value care and assign a catchy slogan to the effort: Image gently for appendicitis or Rest is best for bronchiolitis.

And then we get T-shirts made. We get mouse pads and water bottles made, Bajaj said. People really do enjoy T-shirts.

In California, the Los Angeles County Department of Health Services, one of the largest safety-net health systems in the country, typically receives a fixed dollar amount for each person it covers regardless of how many services it provides. But the staff found that 90% of patients undergoing cataract surgery were getting extensive preoperative testing, a low-value service. In other health systems, that would normally reflect a do-more-to-get-paid-more scenario.

That wasnt the case here in LA County. Doctors didnt make more money, said John Mafi, an associate professor of medicine at UCLA. It suggests that theres many other factors other than finances that can be in play.

As quality improvement staffers at the county health system looked into the reasons, they found the system had instituted a protocol requiring an X-ray, electrocardiograms, and a full set of laboratory tests before the surgery. A records review showed those extra tests werent identifying problems that would interfere with an operation, but they did often lead to unnecessary follow-up visits. An anomaly on an EKG might lead to a referral to a cardiologist, and since there was often a backlog of patients waiting for cardiology visits, the surgery could be delayed for months.

In response, the health system developed new guidelines for preoperative screenings and relied on a nurse trained in quality improvement to advise surgeons when preoperative testing was warranted. The initiative drove down the rates of chest X-rays, EKGs, and lab tests by two-thirds, with no increase in adverse events.

The initiative lot money in its first year because of high startup costs. But over three years, it resulted in modest savings of about $60,000.

A fee-for-service-driven health system where they make more money if they order more tests, they would have lost money, Mafi said, because they make a profit on each test.

Even though the savings were minimal, patients got needed surgeries faster and did not face a further cascade of unnecessary testing and treatment.

Fendrick said some hospitals make more money providing all those tests in preparation for cataract surgery than they do from the surgeries themselves.

These are older people. They get EKGs, they get chest X-rays, and they get bloodwork, he said. Some people need those things, but many dont.

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk Related Topics Health Care Reform Health Industry Insurance States Colorado Doctors Hospitals Contact Us Submit a Story Tip

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Kiley McDaniel’s favorite Day 1 draft picks, biggest surprises and best available Day 2 prospects

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Kiley McDaniel's favorite Day 1 draft picks, biggest surprises and best available Day 2 prospects

With Day 1 of the 2025 MLB draft complete, it’s time to look at which picks in the first round stood out most.

After weeks of speculation about the various directions the Washington Nationals could go with the No. 1 pick, they surprised the industry by taking Oklahoma high school shortstop Eli Willits — and the Los Angeles Angels followed up with a surprising pick of their own at No. 2 by taking UC Santa Barbara pitcher Tyler Bremner

Though the nature of the baseball draft means that some of the picks we aren’t quite sure about on Day 1 will become clearer when we see how teams spread their bonus allotment around later in the draft, here are the early picks I liked the most and some eye-opening selections along with the top players still available entering Day 2.


Five favorite moves

Mariners and Pirates get their guys

The buzz leading up to the draft was that Kade Anderson was atop the Mariners’ draft board and Seth Hernandez was the top target (after Willits, who wasn’t going to get there) of the Pirates. Seattle was the other team taking a long look at Hernandez, but the shenanigans at the top two picks (more on that later) means that both Seattle and Pittsburgh got their preferred arms.

A’s select Arnold and Taylor

The Athletics had only two picks on Day 1 but received excellent values at each. Jamie Arnold was the top prospect in the draft entering the season and seemed primed to go somewhere between No. 2 and No. 8 after an uneven season. He somehow was the prospect left holding the short straw, falling to the 11th pick. Devin Taylor was in the mix at multiple picks in the comp round but lasted five selections into the second round.

Twins embrace risk with Quick and Young

The Twins took two hit-first college infielders as their first picks last year (Kaelen Culpepper and Kyle DeBarge), took another one in the 2023 second round (Luke Keaschall), and two more in the top two rounds in 2022 (Brooks Lee, Tanner Schobel) — and also took one with their first pick this year in Marek Houston.

What interested me though is what Minnesota did after that, taking big swings with the upside of Riley Quick (four potential plus pitches but below-average command) and Quentin Young (80-grade power potential with big questions on contact rate).

Phillies try to jump the reliever trade market?

Gage Wood has a chance to start long term but can also go straight to the upper minors — if not the big leagues — and potentially help the bullpen later this season, like a trade deadline addition. The Phillies’ next pick, Cade Obermueller, is another possible starter who also could move quickly as a lefty turning 22 later this month with two knockout pitches in his fastball/slider combo. Odds are good that at least one of them can provide big league value in the next 12 months if Philly wants to utilize them that way.

The Red Sox land Witherspoon, Phillips and Eyanson

The Red Sox are interested in creating more pitching depth and selected a number of interesting arms on Day 1. Kyson Witherspoon had a lot of interest in the top 10, but the Red Sox got him at No. 15.

He’ll need to sharpen his execution a notch and his short arm action is unique, but there’s midrotation upside. Marcus Phillips has a chance to start but could also bring another distinctive look as a late-inning arm with four plus pitches from a low slot and a triple-digit fastball. Anthony Eyanson is a different sort, with fringy fastball velocity but standout command along with a slider and splitter that keep hitters off-balance.

Five eye-openers

Eli Willits at No. 1

The buzz ahead of the draft was that there were three players in play for the top pick and Willits was my third-ranked player in the class, so the same group is what I would’ve been considering — and I love Willits as a player. The bonus will be a factor in evaluating how successful this pick will be viewed — I’ll guess it starts with an eight — but I think this will be seen as a solid decision, as long as Kade Anderson or Ethan Holliday don’t become stars.

Tyler Bremner at No. 2

The biggest piece of late buzz I was hearing is that Bremner was in play at No. 3 to the Mariners. I didn’t hear his name at all at No. 2 so that made this pick the first shocker in the draft.

Bremner was considered in this area (on a deal) because he could easily be the best pitcher in this class — but only if he can develop a better slider, which isn’t a small if. The Angels seem to have a thought about how to solve this, and how he progresses will be one of the more followed storylines of this draft.

Tigers take Yost and Oliveto

I like both players, but it’s fascinating that these two and the most-rumored prep hitter tied to Detroit that they didn’t take (Coy James, who had a tough summer) were all missing strong 2024 summer performances.

Jordan Yost and Michael Oliveto were the only two prep position players in the first-round mix who weren’t in the major national events on the summer circuit, thus creating a lot of uncertainty about how to project them.

The Tigers are right to assume this could create a potential quick gain in value if Yost and Oliveto can perform early in their pro careers, but I don’t remember seeing a team double down on lack of summer exposure in the early rounds.

Orioles take two catchers in the first round, and two pitchers in the second

It’s certainly a bit odd that the Orioles took two college catchers with their first two picks after taking another one (Ethan Anderson) in the second round last year. Obviously, teams don’t draft for big league need — the O’s already have Adley Rutschman — and they need at least two catchers at all four full season minor league affiliates, it’s just odd to see them invest in this position early multiple times. And after all of the position players they have drafted under Mike Elias, they did sneak in two arms on Day 1 with Joseph Dzierwa (a command-forward lefty) and J.T. Quinn (one of my favorite college relievers with the traits to start in pro ball).

Guardians lean into power

The Guardians often draft, or sign internationally, hit-first players who are often underpowered, with Steven Kwan a prominent example. They swerved a lot this year, taking Jace LaViolette with their first pick (I compare him to Cody Bellinger or Joey Gallo; he hit .258 this season) and Nolan Schubart (24% strikeout rate, 22% in-zone whiff rate) with their fifth pick on Day 1. Those two have big power and strong pull/lift rates, and LaViolette has the athleticism to play center field, so there’s real talent, it’s just not usually the type that the Guardians have targeted.


Best available for Day 2

Listed by top 250 draft rankings

43. Mason Neville, OF, Oregon
44. Matthew Fisher, RHP, Evansville Memorial HS (Ind.)
53. Josiah Hartshorn, LF, Orange Lutheran HS (Calif.)
55. Brock Sell, CF, Tokay HS (Calif.)
61. Jack Bauer, LHP, Lincoln Way East HS (Ill.)
69. Coy James, SS, Davie County HS (N.C.)
70. Alec Blair, CF, De La Salle HS (Calif.)
71. Mason Pike, RHP, Puyallup HS (Wash.)
72. Cam Appenzeller, LHP, Glenwood HS (Ill.)
73. Briggs McKenzie, LHP, Corinth Holders HS (N.C.)

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Gregg Wallace: Over half of allegations against MasterChef presenter upheld, including one of unwanted physical contact

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Gregg Wallace: Over half of allegations against MasterChef presenter upheld, including one of unwanted physical contact

An investigation into Gregg Wallace’s “inappropriate behaviour” on MasterChef has found more than half of the allegations against him have been substantiated, including one of “unwanted physical contact”.

MasterChef’s production company Banijay UK shared a summary of its report into historical allegations of misconduct against the 60-year-old presenter, carried out by independent law firm Lewis Silkin over seven months.

The report said the number of sustained allegations made Wallace’s return to MasterChef “untenable”.

Last week it emerged Wallace had been sacked as MasterChef presenter, with reports of more than 50 fresh allegations against him.

The investigation heard evidence from 78 witnesses, including 41 complainants. The investigations team spoke to Wallace three times for the report, conducting 14 hours of interviews with him.

There were 83 allegations against Wallace, and 45 of them were upheld. All were related to MasterChef.

The upheld allegations were:

• Twelve claims he made inappropriate jokes and innuendo;

• Sixteen reports he made sexually explicit comments;

• Two allegations that he made sexualised comments to or about someone;

• Four complaints that he made culturally insensitive or racist comments;

• Three claims that he was in a state of undress;

• Seven allegations of bullying;

• One allegation of unwanted touching.

Nearly all the allegations against Wallace were related to behaviour which is said to have occurred between 2005 and 2018, with just one substantiated allegation taking place after 2018.

Wallace and Anne-Marie Sterpini in 2014
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Wallace and Anne-Marie Sterpini in 2014

Ahead of the publication of the summary, Wallace had said he had been “cleared of the most serious and sensational accusations” made against him.

He also said his neurodiversity had “now formally (been) diagnosed as autism”, saying in the social media post that it was “suspected and discussed by colleagues across countless seasons of MasterChef”.

BBC held no ‘central’ information over Wallace concerns

Additionally, the report summary found there were 10 standalone allegations about other people between 2012 and 2018/2019, two of which were substantiated. These were unrelated to Wallace, and those people were not named in the summary.

The investigation found that complaints had previously been raised with the production company between 2005 and 2024.

Gregg Wallace on MasterChef. Pic: BBC/ Shine TV 2024
Image:
Gregg Wallace on MasterChef. Pic: BBC/ Shine TV 2024

While the report flagged inadequate reporting procedures before 2016, when Endemol merged with Shine ahead of Banijay acquiring Endemol Shine in 2020, it said there were significant improvements to HR processes and training after 2016.

The investigation said some formal action was taken by the BBC in 2017, but it also noted the corporation held no information regarding concerns raised over Wallace centrally, resulting in issues being addressed as a first offence.

Sky News has tried to contact Gregg Wallace today.

Gregg Wallace after being made a Member of the Order of the British Empire (MBE) by the Princess Royal in an investiture ceremony at Windsor Castle. Picture date: Tuesday February 28, 2023.
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Picture by: Andrew Matthews/PA Archive/PA Images
Date taken: 28-Feb-2023
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Gregg Wallace after being made a Member of the Order of the British Empire (MBE) by the Princess Royal in an investiture ceremony at Windsor Castle. Picture date: Tuesday February 28, 2023.
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Picture by: Andrew Matthews/PA Archive/PA Images


Responding to the findings of the report, the BBC said the corporation had “no plans to work with [Wallace] in future”, saying his behaviour “falls below the values of the BBC”.

The BBC said “opportunities were missed” to address Wallace’s behaviour, adding, “We accept more could and should have been done sooner”.

Concerning the allegations against other individuals flagged in the report, the BBC said they had asked Banijay UK to take action to address these issues, and said it would “be completed as a priority”.

The corporation has yet to decide if the unseen MasterChef series that was filmed with Wallace last year will still be aired.

Production staff deserve ‘much, much better’

Banijay UK chief executive Patrick Holland called the report “uncomfortable reading”, but said its findings provided “valuable insight” for production teams moving forward.

In a nod to Wallace’s recent autism spectrum disorder diagnosis, Mr Holland said Wallace’s neurodiversity was “relevant to certain behaviours identified in the report”, admitting “the production could have done more to identify, manage and communicate patterns of inappropriate behaviour”.

Philippa Childs, head of creative industries union Bectu, said the report findings made it clear that “inappropriate behaviour has gone unchecked for far too long,” adding: “This is a real failure by Banijay to take these issues seriously and act accordingly”.

Ms Childs said the report highlighted the precarious position of production staff, the majority of whom are freelance workers, who she said deserve “much, much better”.

Wallace was the original presenter of the BBC show Saturday Kitchen in 2002 and has also featured on Eat Well For Less?, Inside The Factory, Turn Back Time, Harvest and Supermarket Secrets.

He was best known, however, for presenting MasterChef, MasterChef: The Professionals, and Celebrity MasterChef.

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Postman who murdered and beheaded girlfriend jailed for at least 23 years

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Postman who murdered and beheaded girlfriend jailed for at least 23 years

Warning: This article contains details readers may find distressing.

An “evil” postman who moaned about being lonely hours before he severed his girlfriend’s head and tried to dismember her body has been jailed for a minimum of 23 years.

Ewan Methven murdered 21-year-old Phoenix Spencer-Horn in the flat they shared in East Kilbride, South Lanarkshire, in November last year.

The High Court in Glasgow heard the killer dumped his partner’s body parts in their hallway and failed to call emergency services for two days.

Phoenix Spencer-Horn
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Phoenix Spencer-Horn was murdered in November

The 27-year-old then bought drugs, watched pornography and sent sickening texts to Phoenix’s worried mum pretending she was still alive.

Phoenix was stabbed 20 times – including 10 times in the face – using three knives in an attack that unfolded after she returned from her waitressing job in Lanarkshire.

The 21-year-old had described Methven as her “soulmate” on social media, saying in one TikTok video: “Life is so much more beautiful and full of colour with you.”

A few months later she was murdered by the same man she had been in a relationship with for two years.

Ewan Methven.
Pic Police Scotland/PA
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Ewan Methven was jailed on Monday. Pic: Police Scotland

Methven received a life sentence with at least 23 years behind bars when he retuned to the dock on Monday.

The judge, Lord Matthews, described it as a “dreadful crime”.

He told Methven: “You were a trusted member of her family, but you betrayed that trust and robbed her of life in the cruellest way.

“Not content with what you had done to her, you robbed her of all dignity in death by decapitating her and trying to dismember her in an attempt to defeat the ends of justice.”

The pair had been in a relationship for two years.
Image:
The pair had been in a relationship for two years

Lord Matthews highlighted victim impact statements supplied by Phoenix’s family and said he had “rarely read such outpourings of grief”.

The judge said: “The way you treated this innocent young woman after her death meant that her family did not even have the comfort of saying goodbye to her.”

He added: “I have this morning seen a letter written by you, but it answers none of the questions which must be plaguing the family. You blame the effect of substances but that is no excuse.”

‘Personification of evil’

Sky News has interviewed the couple’s neighbour who lives directly next door.

Toni Brown, 25, described the horror of discovering what happened.

She said: “I think I stayed out of the house for about a week after that. I couldn’t even sit.

“It’s horrific. It gives me shivers thinking about it. It is crazy to think I stayed next door to a monster like that.

“What scares me the most is knowing she was lay there and I was in here oblivious.”

Toni Brown
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Neighbour Toni Brown spoke to Sky News

Asked whether she heard any noises or violence around the time of the murder, Ms Brown said: “There was a bad smell in my house in the early hours of the morning she was found.

“There was a bad smell in my kitchen basically where the walls join together.”

Methven’s own defence lawyer told the court that society will see the killer as the “personification of evil”.

When he eventually called 999, he claimed to have suffered a drug-induced blackout during the violent killing.

Phoenix Spencer-Horn was murdered by the man she once called her "soulmate"
Image:
Ms Spencer-Horn was murdered by the man she once called her ‘soulmate’

Another life lost to gender-based violence

The case has raised questions once again about the growing prevalence of gender-based violence.

Fiona Drouet’s daughter Emily was 18 when she took her own life at university in Aberdeen in 2016, days after being choked and slapped by her ex-boyfriend.

Angus Milligan was later convicted of physical and psychological abuse.

Fiona Drouet
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Fiona Drouet’s daughter was a victim of physical abuse from an ex-boyfriend

Ms Drouet, who now campaigns on violence against women across the UK and Ireland, has set up a charity called Emily’s Test in her daughter’s name.

Reacting to the death of Ms Spencer-Horn, Ms Drouet told Sky News: “There is another mother and father that have just been plunged into utter hell.

“Somebody once said to me that if God came to you and said, ‘I am going to give you this beautiful daughter, but you’ll only have her for 18 years and then we need to take her back, would you still want her?’ and I would take those 18 years and go through the pain rather than have nothing.

“Although just now that probably offers no words of comfort for Phoenix’s parents, maybe one day it can.”

If you suspect you are being abused and need to speak to someone, there are people who can help you, including The National Domestic Violence Helpline on 0808 2000 247 or Women’s Aid online.

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