Patients face serious risk of complications; billions in Medicare dollars wasted
BOSTON—Physicians performed more than 200,000 unnecessary back surgeries on older adults, according to a new analysis from the Lown Institute analyzing three years of Medicare claims.
The surgeries took place despite medical research showing they provide little to no clinical benefit and come with serious risks. Complications of spinal fusion, one of the procedures studied, can occur in up to 18% of patients and include the risk of developing infection, blood clots, stroke, pneumonia, heart and lung problems, and even death.
The report estimates these unnecessary procedures cost Medicare $1.9 billion.
“Like everyone in America, older people with back pain deserve safe, evidence-based care that doesn’t waste taxpayer dollars,” said Vikas Saini, MD, president of the Lown Institute. “Reducing unnecessary procedures, particularly invasive ones that carry grave risks, is a moral imperative. Physicians, policymakers, and hospitals must act to protect their constituents and patients.”
Spinal fusion overuse: Top ten states by total volume
Rates of overuse for spinal fusion, a procedure that joins two or more bones in the spine together, varied widely among hospitals in the same state. For example, at Wellspan York Hospital in Pennsylvania, 7.4% of spinal fusions met criteria for overuse, while the rate at Mount Nittany Medical Center was 57.2%.
| State (overuse volume) | Lowest overuse hospital | Rate | Highest overuse hospital | Rate |
|---|---|---|---|---|
| Calif. (6,823) | Fresno Surgical Hospital | 1.4% | Kaiser Permanente Los Angeles Medical Center | 27.1% |
| Fla. (6,495) | Tallahassee Memorial Hospital | 4.0% | Cape Coral Hospital | 33.3% |
| Texas (5,815) | Baylor Surgical Hospital at Las Colinas | 1.2% | Methodist Hospital Stone Oak | 23.1% |
| Pa. (5,041) | Wellspan York Hospital | 7.4% | Mount Nittany Medical Center | 57.2% |
| Ohio (4,882) | UC Medical Center | 4.4% | Crystal Clinic Orthopaedic Center | 34.5% |
| Mich. (3,731) | Beaumont Hospital, Troy | 5.0% | Trinity Health Grand Rapids Hospital | 24.9% |
| N.Y. (3,711) | St. Francis Hospital & Heart Center | 2.2% | Rochester General Hospital | 33.8% |
| Ill. (3,484) | Elmhurst Hospital | 5.2% | Springfield Memorial Hospital | 37.3% |
| Tenn. (3,360) | Erlanger Baroness Hospital | 2.1% | Saint Francis Hospital – Memphis | 27.9% |
| N.C. (3,211) | CaroMont Regional Medical Center | 2.1% | UNC Health Rex | 18.9% |
Vertebroplasty overuse: Top ten states by total volume
Rates of overuse for vertebroplasty, a procedure used to treat painful spinal compression fractures, also varied widely among hospitals in the same state. For example, no patients with osteoporotic spinal fracture at MetroHealth Medical Center in Ohio received a medically unnecessary vertebroplasty, compared to more than 50% of patients at Kettering Health Miamisburg.
| State (overuse volume) | Lowest overuse hospital | Rate | Highest overuse hospital | Rate |
|---|---|---|---|---|
| Texas (9,927) | Parkland Health and Hospital System | 0.4% | Shannon Medical Center | 54.6% |
| Fla. (8,302) | Adventhealth Sebring | 0.0% | Halifax Health Medical Center | 43.2% |
| Ohio (6,803) | Metrohealth Medical Center | 0.0% | Kettering Health Miamisburg | 56.1% |
| Calif. (5,714) | Marshall Hospital | 0.0% | Santa Barbara Cottage Hospital | 35.2% |
| Ill. (5,129) | Advocate Illinois Masonic Medical Center | 0.4% | Northwestern Medicine Kishwaukee Hospital | 31.4% |
| Pa. (4,389) | St Luke’s Hospital – Anderson Campus | 0.3% | St Clair Hospital | 29.6% |
| Mich. (4,168) | Bronson Battle Creek Hospital | 0.6% | Henry Ford Providence Southfield Hospital | 42.0% |
| Mo. (3,882) | University Hospital | 2.9% | Liberty Hospital | 38.4% |
| Mass. (3,446) | Boston Medical Center | 0.2% | MelroseWakefield Hospital | 24.8% |
| Ind. (3,298) | IU Health Methodist Hospital | 3.5% | Lutheran Hospital Of Indiana | 44.1% |
Policy Implications
The Lown Institute’s findings come as the Centers for Medicare & Medicaid Services (CMS) launches efforts targeting overuse of medical services, like its introduction of the WISeR (Wasteful and Inappropriate Service Reduction) program.
WISeR’s list of 17 services includes vertebroplasty, a surgery that Lown’s study confirms is extensively overused on patients.
“The fact that CMS is launching an effort to curb overuse is a welcome and important step toward improving healthcare safety and reducing unnecessary federal spending,” said Dr. Saini.
Methodology
Hospital overuse is measured using Medicare fee-for-service and Medicare Advantage claims data for three years of the most recently available data (2021-2023 for fee-for-service and 2020-2022 for Medicare Advantage).
Spinal fusion and/or laminectomy is defined as overuse for patients with low-back pain who did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Spinal fusion-only cases are not considered overuse for patients with stenosis with neural claudication and spondylolisthesis. Laminectomy-only cases are not considered overuse for patients with stenosis who had neural claudication. Only hospitals with high volume (at least 500 procedures) are identified as having high or low overuse rates. Rate of overuse is measured as the proportion of spinal fusion and/or laminectomy that met criteria for overuse.
Vertebroplasty is defined as overuse for patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma, or hemangioma. Only hospitals with high volume (at least 500 patient visits for osteoporotic spinal fracture) are identified as having high or low overuse rates. Rate of overuse is measured as the proportion of patients with osteoporotic spinal fracture who received an unnecessary vertebroplasty.
Learn more about the methodology.
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About the Lown Institute
The Lown Institute is an independent think tank advocating bold ideas for a just and caring system for health. We envision a healthcare system focused on what’s best for people, like hospitals caring for those most in need, patients living without fear of financial distress, and health professionals finding joy in their roles. The Lown Hospitals Index, a signature project of the Institute, is the first ranking to assess the social responsibility of U.S. hospitals by applying measures never used before like community investment, medical overuse, and CEO pay.
Contact
Aaron Toleos, Lown Institute, (978) 821-4620, atoleos@lowninstitute.org