Hospitals Performed 100K Low-Value Procedures During Pandemic

Hospitals performed more than 100,000 low-value procedures on Medicare beneficiaries in 2020, contributing to the high rate of hospital overuse during the COVID-19 pandemic, according to an analysis from the Lown Institute.

Low-value care is defined as a medical service that offers little to no clinical benefit or is more likely to harm patients than help them.

The Lown Institute report reflects Medicare claims data from January to December 2020 for eight common low-value services: arthroscopic knee surgery, carotid endarterectomy, coronary artery stenting, hysterectomy, ilnferior vena cava filter, renal artery stenting, spinal fusion/laminectomy, and vertebroplasty.

Between March and December 2020, the first ten months of the pandemic, hospitals performed 106,474 low-value procedures—equivalent to one procedure every four minutes. The rate of hospital overuse between June and December 2020 was similar to the rate in 2019, the report noted.

“You couldn’t go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures,” Vikas Saini, MD, president of the Lown Institute, said in a press release. “The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”

The most overused procedure was coronary stents, with 45,176 instances. Vertebroplasty for osteoporosis followed, with 16,553 procedures. Hospitals performed 14,455 hysterectomies for benign diseases and 13,541 spinal fusions for back pain.

Research has shown that receiving low-value services can increase the risk of direct harm.

The high volume of coronary stents was a particular area of concern, researchers noted. Coronary stenting has shown to be no more beneficial than medication therapy for patients with stable coronary disease.

During a coronary stent procedure, a wire mesh stent is used to open a blocked artery. Individuals receiving this procedure are at risk of developing blood clots that can lead to stroke or heart attack, injury to the heart arteries, infection at the catheter site, and an allergic reaction to or kidney damage from the dye or contrast used.

Every 1,000 low-value coronary stents performed at hospitals is associated with nine hospital-acquired conditions or patient safety events, the report noted. Additionally, avoiding unnecessary coronary stents for people without symptoms could save an estimated $500 million.

“We’ve known for over a decade that we shouldn’t be putting so many stents into patients with stable coronary disease, but we do it anyway,” said Saini. “As a cardiologist, it’s frustrating to see this behavior continue at such high levels, especially during the pandemic.”

Nineteen hospitals across the country performed at least 200 low-value coronary stents in 2020 and had an overuse rate of more than 30 percent.

NYU Langone Medical center, St. Francis Hospital, Mount Sinai Hospital, Scripps Memorial Hospital, and Cedars-Sinai Medical Center performed more than 300 low-value coronary stents. For these five hospitals, low-value stents made up at least one-third of all stents placed in 2020.

All of the hospitals on the US News Honor Roll had rates of coronary stent overuse above the national average in 2020. Four hospitals, including Cleveland Clinic (44 percent), Houston Methodist Hospital (44 percent), Mount Sinai Hospital (42 percent), and Barnes Jewish Hospital (42 percent), had overuse rates that were at least double the national average.

According to the 2022 Lown Hospitals Index for Social Responsibility, the top five states that avoided hospital overuse were Oregon, Maine, Vermont, Minnesota, and South Dakota.

A separate study from the Lown Institute found that for-profit, non-teaching, and Southern hospitals were more likely to perform high rates of low-value care.

Additionally, data from John Hopkins University revealed that low-value services were seen most often in health systems with more beds and fewer primary physicians and investor-owned health systems saw the highest overuse rates.