Checking in on medical overuse in America

As we prepare for the launch of our 2025 report on unnecessary back surgery (registration now open), let’s take a moment to check in on the current state of medical overuse in America.

At the Lown Institute, we’ve been studying overuse and low-value care for years. We’ve reported on the epidemic of medication overload and the “madness” of unnecessary hysterectomies. Our annual Shkreli Awards highlight extreme examples like the recent surge in infant tongue-tie cutting. And every year as part of the Lown Hospitals Index, we rank thousands of hospitals on how well they avoid overuse of twelve low-value tests and procedures.

With a new Health and Human Services secretary in place, we’ve heard a lot about cutting waste, increasing efficiency, and protecting the public’s health. And over the last several years, we’ve seen many initiatives targeting overuse emerge from the Centers of Medicare & Medicaid Services:

• The Transforming Episode Accountability Model (TEAM) will pay hospitals a target price for a 30-day patient episode for five common surgeries (including the cost of hospitalization, follow-up visits, skilled nursing care, etc), which theoretically will encourage hospitals to coordinate care among the necessary providers to ensure quality and reduce cost. The model begins in January 2026 and is mandatory for 750 selected acute care hospitals.
• The All-Payer Health Equity Approaches and Development (AHEAD) model will provide hospitals in participating states with a “global budget” — essentially an annual salary — that takes into account their previous Medicare and Medicaid payments, the populations they serve, and other factors. So when hospitals avoid unnecessary care and reduce preventable hospitalizations by addressing social needs, they get to keep those savings. This voluntary ten-year program begins in January 2026 or 2027, depending on which cohort states opt into.
• The Wasteful and Inappropriate Service Reduction (WISeR) model will be implemented from January 1, 2026 to December 31, 2031 in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) and require prior authorization from providers for 17 kinds of services identified as being commonly overused or at a higher risk of waste, fraud, and abuse. The program proposes to use AI provided by private companies to identify overuse and for the companies to earn a cut of the savings.

Two of the overuse services targeted by WISeR are ones that the Lown Institute has studied extensively: knee arthroscopy and vertebroplasty. For example, Lown found that from 2020–2023, U.S. hospitals performed 100,000 vertebroplasties and 3,500 knee arthroscopies that met overuse criteria, costing Medicare billions of dollars.

So if you are interested in overuse, WISeR, and unnecessary back surgery (vertebroplasty and spinal fusion), and want to find out which hospitals are best and worst at avoiding them, register for our October 7 zoom event. We’ve got some great guests lined up and would love to see you there!