Which health systems are doing the most to reduce overuse?
Overuse— also known as low-value care or unnecessary care— is widespread in American health care, and poses a significant threat to patient safety and financial sustainability. However, not all hospitals or health systems give patients unnecessary tests and services at equal rates. Identifying the providers who effectively avoid overuse, as well as those who are overuse outliers, can show which policies are working well to reduce low-value care, and point to where more targeted interventions are necessary.
The Lown Hospitals Index was the first to evaluate more than 3,000 hospitals and 300 hospital systems on how well they avoid 12 common low-value services for Medicare patients. Researchers have since conducted analyses of low-value care throughout the system, including outpatient clinics, skilled nursing facilities, and home health agencies.
In a new study in JAMA Health Forum, Dr. Jodi Segal at the Johns Hopkins School of Public Health and colleagues evaluate overuse at 676 health systems using an Overuse Index consisting of 17 low-value services. These services, which include MRIs for patients with mild brain injuries, spinal fusions for back pain and pap smears for women over age 65, are indicators of systemic overuse that have been validated in both Medicare and commercially insured populations.
Dr. Segal and colleagues found that health systems with higher overall rates of overuse had more beds and fewer primary care physicians; they were also more likely to be for-profit systems and less likely to be associated with a major teaching hospital.
More physician groups within a system was also associated with overuse, which means that further hospital consolidation going unchecked could lead to more low-value care.
“As hospitals restructure themselves into larger and larger systems, senior leadership of hospitals will have to own this problem, said Dr. Vikas Saini, in Modern Healthcare.
Although the JHU study and the Lown Index measure overuse of different health services, some of the patterns in these two analyses match up. According to the Lown Index, none of the top hospital systems for avoiding overuse are for-profit systems, although some on the bottom are (see tables below). The Lown Index also found that major teaching hospitals had better rankings on avoiding overuse compared to nonteaching hospitals.
Best health systems for avoiding overuse, 2021
|Name||State||Number of hospitals in system||LIHI overuse rank||LIHI overuse grade|
|UMass Memorial Health Care, Inc.||MA||2-3||1||A|
|Samaritan Health Services||OR||4-9||2||A|
|St. Luke’s Health System||ID||4-9||3||A|
|Northern Light Health||ME||4-9||5||A|
|Virginia Mason Health System||WA||2-3||6||A|
|Central Maine Healthcare||ME||2-3||8||A|
|Beth Israel Lahey Health||MA||4-9||10||A|
|North Memorial Health Care||MN||2-3||12||A|
|Centra Health, Inc.||VA||2-3||13||A|
|Legacy Health||WA, OR||4-9||15||A|
|Essentia Health||WI, MN, ND, ID||10-19||19||A|
|Mayo Clinic||FL, WI, MN, IA, AZ||20-39||20||A|
Worst health systems for avoiding overuse, 2021
|Name||State||Number of hospitals in system||Ownership type||LIHI overuse rank||LIHI overuse grade|
|Central Florida Health||FL||2-3||Nonprofit||311||D|
|Methodist Health System||TX||2-3||Nonprofit||310||D|
|Houston Healthcare System||GA||2-3||Nonprofit||309||D|
|Curae Health||AL, MS||2-3||Nonprofit||306||D|
|Baptist Health South Florida||FL||4-9||Nonprofit||305||D|
|Rush Health Systems||MS||2-3||Nonprofit||304||D|
|Regional Medical Center||AL||2-3||Nonprofit||302||D|
|Memorial Healthcare System||FL||2-3||Nonprofit||301||D|
|Mary Washington Healthcare||VA||2-3||Nonprofit||300||D|
|Union General Hospital, Inc.||GA||2-3||Nonprofit||299||D|
|Greater Hudson Valley Health System||NY||2-3||Nonprofit||298||D|
|Physicians for Healthy Hospitals||CA||2-3||For-profit||297||D|
|Hackensack Meridian Health||NJ||4-9||Nonprofit||295||D|
|Allegiance Health Management||AR, LA||4-9||For-profit||294||D|
The JHU researchers found that St. Dominic’s health system in Jackson, MS, had the worst score of any system on their overuse index. On the Lown Index, St. Dominic-Jackson Memorial Hospital, which is part of that system, also scored poorly on avoiding overuse.
In Modern Healthcare, a St. Dominic’s official said that they are “committed to exploring this study and taking any necessary actions to ensure our patients, community and region receive the most exceptional, safe and effective care.” If research like the JHU study and the Lown Index can prompt system leaders to reduce unnecessary care, that’s a big step in the right direction.