Many hospital doctors continue to perform unnecessary medical procedures and surgeries every year, according to a new report out from nonpartisan healthcare think tank the Lown Institute.
The first annual Hospitals Index found that in the U.S., for-profit, non-teaching and southern hospitals were associated with the highest rates of overuse. Hospitals like Houston Methodist Sugarland Hospital in Texas, CHI St. Luke’s Health Memorial Livingston in Tenn. and Adventist Healthcare Fort Washington Medical Center in Md. all scored in the bottom 50 hospitals as having the most Medicare claims for 12 unnecessary tests, procedures and surgeries.
“These are things that are generally low value – tests and procedures that you don’t really see health improvements or functional improvements,” said Dr. Vikas Saini, president of the Lown Institute. “So the money spent is waste. These are the tip of the iceberg of overuse, because this is the stuff that are very black and white.”
The rankings are from over 3,100 hospitals of more than 1 million tests and procedures from Medicare claims in a two-year period between 2016 and 2018. The Lown Institute looked at claims for patients who’d had hysterectomies without a cancer diagnosis and vertebroplasty for patients with spinal fractures caused by osteoporosis, where cement is injected into vertebrae.
“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.”
The Cleveland Clinic ranked as the #1 hospital that performed the most unnecessary vertebroplasties, and in Florida alone, more than 3,600 vertebroplasties were performed in the years studied.
Among the 12 low-value services measured, hysterectomy for benign disease, the placement of coronary stents for stable heart disease, and diagnostic tests like head imaging for fainting, were all widespread, with more than 90% of hospitals overusing these tests or procedures. The Lown Institute also found that 64% of all hysterectomies, 44% of carotid endarterectomies and 24% of coronary stent procedures met criteria for overuse nationwide.
In North Dakota and Wyoming, the rate of hysterectomy overuse was 90% and 94%, respectively. The University of Wisconsin Hospitals and Clinics Authority performed the most unnecessary hysterectomies.
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.”