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

NameStateNumber of hospitals in systemLIHI overuse rankLIHI overuse grade
UMass Memorial Health Care, Inc.MA2-31A
Samaritan Health ServicesOR4-92A
St. Luke’s Health SystemID4-93A
MaineHealthME, NH4-94A
Northern Light HealthME4-95A
Virginia Mason Health SystemWA2-36A
HealthPartnersWI, MN4-97A
Central Maine HealthcareME2-38A
Beth Israel Lahey HealthMA4-910A
Vanderbilt HealthTN2-311A
North Memorial Health CareMN2-312A
Centra Health, Inc.VA2-313A
Carle FoundationIL2-314A
Legacy HealthWA, OR4-915A
UC HealthOH2-316A
Nuvance HealthCT2-317A
Lifespan CorporationRI2-318A
Essentia HealthWI, MN, ND, ID10-1919A
Mayo ClinicFL, WI, MN, IA, AZ20-3920A
Top 20 hospital systems for avoiding overuse on the Lown Hospitals Index. All of these are nonprofit systems.

Worst health systems for avoiding overuse, 2021

NameStateNumber of hospitals in systemOwnership typeLIHI overuse rankLIHI overuse grade
Central Florida HealthFL2-3Nonprofit311D
Methodist Health SystemTX2-3Nonprofit310D
Houston Healthcare SystemGA2-3Nonprofit309D
Baptist HealthAL2-3Nonprofit308D
Houston MethodistTX4-9Nonprofit307D
Curae HealthAL, MS2-3Nonprofit306D
Baptist Health South FloridaFL4-9Nonprofit305D
Rush Health SystemsMS2-3Nonprofit304D
McLeod HealthSC4-9Nonprofit303D
Regional Medical CenterAL2-3Nonprofit302D
Memorial Healthcare SystemFL2-3Nonprofit301D
Mary Washington HealthcareVA2-3Nonprofit300D
Union General Hospital, Inc.GA2-3Nonprofit299D
Greater Hudson Valley Health SystemNY2-3Nonprofit298D
Physicians for Healthy HospitalsCA2-3For-profit297D
LifeBridge HealthMD2-3Nonprofit296D
Hackensack Meridian HealthNJ4-9Nonprofit295D
Allegiance Health ManagementAR, LA4-9For-profit294D
CarePoint HealthNJ2-3For-profit293D
Broward HealthFL2-3Nonprofit292D
Bottom 20 hospital systems for avoiding overuse on the Lown Hospitals Index.

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.