Pointless again surgical procedures value Medicare $1.9B: Lown

Dive Transient:

• Hospitals charged Medicare greater than $1.9 billion over three years for greater than 200,000 pointless, “low-value” again surgical procedures for older adults, in accordance with a new evaluation of claims knowledge from the Lown Institute.
• That quantities to at least one pointless again process each eight minutes, in accordance with the report, which analyzed the charges of spinal fusions and vertebroplasties — or surgical procedures that inject medical-grade cement into damaged spinal bones to alleviate ache.
• Again surgical procedures have come beneath scrutiny because of the excessive threat of issues — together with together with an infection, blood clots and strokes — which may happen in as much as 18% of sufferers, in accordance with the report. “Lowering pointless procedures, significantly invasive ones that carry grave dangers, is an ethical crucial,” Dr. Vikas Saini, president of Lown, stated in a assertion.

Dive Perception:

Again surgical procedures have confronted criticism for lackluster well being outcomes and excessive bills because the procedures have grown in reputation. Research have discovered the surgical procedures enhance healthcare spending and not using a corresponding enhance in well being outcomes — sufferers may even develop new ache following spinal surgical procedure, referred to as “failed again surgical procedure syndrome.”

The surgical procedures may also be dangerous. For spinal fusions, over 17,000 sufferers skilled pointless issues out of 99,000 who underwent the process, in accordance with the Lown Institute, which analyzed Medicare claims knowledge from 2020 to 2023.

As a result of dangers and prices of the procedures, Medicare has pushed for extra oversight of again surgical procedures, and has focused them as one space to doubtlessly scale back spending. Vertebroplasties have been together with within the CMS’ checklist of 17 providers that might be included in a Medicare prior authorization pilot subsequent yr, which the company launched to cut back pointless spending in this system.

Lown outlined pointless spinal fusions as these for sufferers with low-back ache and not using a herniated disc, trauma, scoliosis or different severe circumstances. Likewise, pointless vertebroplasties have been rated for sufferers with spinal fractures attributable to osteoporosis, and excluded fractures for different circumstances like bone most cancers. 

The typical overuse fee for spinal fusions was 13% for all U.S. hospitals, in comparison with 10% with vertebroplasties, in accordance with Lown. Texas and Florida had among the highest volumes of each spinal fusion and vertebroplasty overuse.

Some hospitals carried out extra pointless again surgical procedures than others. One in three spinal fusions at many hospitals with the best charges of overuse have been pointless, in accordance with Lown.

Among the many U.S. Information hospital honor position — a prestigious annual checklist of the perfect hospitals within the U.S. — AdventHealth Orlando and Brigham and Girls’s Hospital had among the highest quantities of pointless procedures.

Mount Nittany Medical Heart in Pennsylvania, Harmony Hospital in New Hampshire and Lutheran Hospital of Indiana had the best overuse charges for spinal fusion surgical procedures.

For vertebroplasties, Kettering Well being Miamisburg in Ohio, Shannon Medical Heart in Texas and Saint Elizabeth Florence Hospital in Kentucky had the best charges of overuse.