Hospitals performed over 200,000 unnecessary back surgeries on older adults over a three-year period, and billed Medicare more than $1.9 billion for those low-value services, according to a Lown Institute analysis published last week.
The review of Medicare fee-for-service (2021-2023) and Medicare Advantage (2020-2022) claims looked at hospitals’ rates of spinal fusions/laminectomies and vertebroplasties that met the researchers’ criteria of a low-value procedure based on the patient’s presentation—for instance, a vertebroplasty was considered overuse for most patients with spinal fractures stemming from osteoporosis.
Also of note, the analysis found that 60% of total overuse for spinal fusion/laminectomies came from the 10% of worst offender physicians.
Beyond the costs, the Lown Institute’s researchers warned that these unnecessary procedures bring a rise in serious complications. For instance, spinal fusion complications occur in up to 18% of patients and can lead to stroke, pneumonia or death.
“Like everyone in America, older people with back pain deserve safe, evidence-based care that doesn’t waste taxpayer dollars,” Vikas Saini, M.D., president of the Lown Institute, said in a release. “Reducing unnecessary procedures, particularly invasive ones that carry grave risks, is a moral imperative.”
The Lown Institute and Saini noted that vertebroplasty is among 17 services targeted in a Center for Medicare and Medicaid Services’ prior authorization pilot, called the Wasteful and Inappropriate Service Reduction (WISeR) Model, that will run in six states for six performance years beginning Jan. 1. The voluntary model will use a combination of artificial intelligence, machine learning and human clinical review to expedite reviews of, and ultimately decrease low-value use of, the 17 services.
“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,” Saini said.
The Lown Institute’s review included 2,547 hospitals with claims data available for spinal fusions/laminectomies and 2,412 for vertebroplasty. Average overuse rates for the former group was 13%, while the latter procedure had an average of 10% rate of overuse.
Among these hospitals with at least 500 procedures performed over three years, the group outlined high and low performers at both the national and state level.
For spinal fusion/laminectomy, Avala in Louisiana and Northwest Specialty Hospital in Idaho logged overuse rates of less than 1% while Mount Nittany Medical Center in Pennsylvania topped the overusers with a 57.2% rate.
For vertebroplasty, the Lown Institute found 11 hospitals with a 0% rate of overuse, but three hospitals with rates over 50%: Kettering Health Miamisburg in Ohio (56.1%), Shannon Medical Center in Texas (54.6%) and St. Elizabeth Florence Hospital in Kentucky (50.1%).
One section of the report focused specifically on the wide variety within the overuse rates of hospitals that received top marks in the U.S. News and World Report annual Best Hospitals List.
For instance, the Cleveland Clinic and the University of Michigan Health System both had vertebroplasty overuse rates below 1%, as opposed to the 22.7% of AdventHealth Orlando or the 18% of Mayo Clinic Hospital, Phoenix. That same Mayo Clinic location scored well on spinal fusion/laminectomy overuse with a 6.3% rate, while the Hospital of the University of Pennsylvania logged a 33.3% overuse rate and Stanford Hospital hit 22.7%.
“Physicians, policymakers and hospitals must act to protect their constituents and patients,” Saini said of the findings.