Dive Brief:
- Hospitals charged Medicare more than $1.9 billion over three years for more than 200,000 unnecessary, “low-value” back surgeries for older adults, according to a new analysis of claims data from the Lown Institute.
- That amounts to one unnecessary back procedure every eight minutes, according to the report, which analyzed the rates of spinal fusions and vertebroplasties — or surgeries that inject medical-grade cement into broken spinal bones to relieve pain.
- Back surgeries have come under scrutiny due to the high risk of complications — including including infection, blood clots and strokes — which can occur in up to 18% of patients, according to the report. “Reducing unnecessary procedures, particularly invasive ones that carry grave risks, is a moral imperative,” Dr. Vikas Saini, president of Lown, said in a statement.
Dive Insight:
Back surgeries have faced criticism for lackluster health outcomes and high expenses as the procedures have grown in popularity. Studies have found the surgeries increase healthcare spending without a corresponding boost in health outcomes — patients can even develop new pain following spinal surgery, called “failed back surgery syndrome.”
The surgeries can also be risky. For spinal fusions, over 17,000 patients experienced unnecessary complications out of 99,000 who underwent the procedure, according to the Lown Institute, which analyzed Medicare claims data from 2020 to 2023.
Due to the risks and costs of the procedures, Medicare has pushed for more oversight of back surgeries, and has targeted them as one area to potentially reduce spending. Vertebroplasties were including in the CMS’ list of 17 services that will be included in a Medicare prior authorization pilot next year, which the agency launched to reduce unnecessary spending in the program.
Lown defined unnecessary spinal fusions as those for patients with low-back pain without a herniated disc, trauma, scoliosis or other serious conditions. Likewise, unnecessary vertebroplasties were rated for patients with spinal fractures caused by osteoporosis, and excluded fractures for other conditions like bone cancer.
The average overuse rate for spinal fusions was 13% for all U.S. hospitals, compared to 10% with vertebroplasties, according to Lown. Texas and Florida had some of the highest volumes of both spinal fusion and vertebroplasty overuse.
Some hospitals performed more unnecessary back surgeries than others. One in three spinal fusions at many hospitals with the highest rates of overuse were unnecessary, according to Lown.
Among the U.S. News hospital honor role — a prestigious annual list of the best hospitals in the U.S. — AdventHealth Orlando and Brigham and Women's Hospital had some of the highest amounts of unnecessary procedures.
Mount Nittany Medical Center in Pennsylvania, Concord Hospital in New Hampshire and Lutheran Hospital of Indiana had the highest overuse rates for spinal fusion surgeries.
For vertebroplasties, Kettering Health Miamisburg in Ohio, Shannon Medical Center in Texas and Saint Elizabeth Florence Hospital in Kentucky had the highest rates of overuse.
