Overuse of unnecessary healthcare services was most common among for-profit hospitals, nonteaching hospitals and those located in the southern U.S., according to a new review of Medicare claims conducted by the Lown Institute. The study found more than 1.3 million low-value tests and procedures delivered by 3,351 U.S. hospitals between Jan. 1, 2015, and Dec. 31, 2017—a rate of one such unnecessary service delivered to an older adult every 80 seconds. More

In what was called a first-of-its-kind list, the Lown Institute on Tuesday released the names of the worst 50 and best 50 hospitals ranked by how frequently their patients had any of 12 procedures largely regarded as unnecessary. Lown president Vikas Saini, MD, said for the hospitals with the most overuse, "it appears there is a culture. The evidence that these procedures are not useful hasn't penetrated or is being ignored." Saini warned that overuse isn't just a matter of the hospitals performing more revenue-generating procedures; patients could be harmed. "When you're getting stuff done that's not necessary, you are subjecting yourself to a risk of harm, and even if the harm is very small, even if the risk is small, it's still real," he said, especially if you're the unfortunate person that develops that complication. More

"Like so much in American healthcare, the practice outran the evidence: there have been randomized trials that have shown that vertebroplasty for osteoporosis in the elderly is not an effective therapy," Saini said. "New people who are getting into the field may not do it, but people who always did it, they're always going to say, 'Well, I don't trust that evidence, it works for me.' There's a lot of that in medicine."

Saini said it will take doctors to personally decide to no longer order unnecessary tests and procedures.

"But hospitals are also often willing participants because some of this needs fancy, expensive equipment," Saini said. "So when the hospital incurs a capital cost, you get a situation where now you got to pay off that investment, and I think it's a sort of mutual back scratching that happens."

The Institute wants to see doctors and hospital administrators take a hard look at what procedures they do first as the pandemic recedes in much of the country and elective surgeries begin again. Saini wants to see unnecessary tests integrated into safety and quality rankings, instead of just including measures like complications and infections.

"Whether or not you really even need this care ought to be one of the fundamental pillars of what quality means," Saini said. "But there has not been a national framework in which, for example, the Joint Commission on Accreditation, or NQF, or any of these folks, really made this a fundamental plank of their mission."

Houston boasts of being home to the Texas Medical Center, the world's biggest medical complex. Yet Houston's medical community also holds a distinction that's hardly boast-worthy: It's the worst major metro area in Texas for unnecessary health care tests and procedures. "Overuse in American hospitals is a pervasive problem that needs to be addressed," Dr. Vikas Saini, president of the Lown Institute, says in a news release. "Hospitals want to do better, and these objective measures of performance can help them move forward."