More Than 100K Medicare Patients Had Unnecessary Surgeries in First Year of Pandemic

The negative consequences of unnecessary surgeries include avoidable complications, increased costs of care, and opportunity costs.

Unnecessary surgeries, which have plagued U.S. healthcare for years, persisted during the first year of the coronavirus pandemic, according to a new analysis by the Lown Institute.

Last year, the Lown Institute, a nonprofit healthcare think tank based in Needham, Massachusetts, reported that hospitals performed more than 1 million unnecessary tests and procedures on Medicare patients from 2016 to 2018. Unnecessary tests and procedures can put patients at risk of complications and drive up the cost of care.

The new analysis found that hospitals performed more than 100,000 low-value procedures on Medicare patients from March to December 2020.

• Stents for stable coronary disease: 45,176
   
• Vertebroplasty for osteoporosis: 16,553
   
• Hysterectomy for benign disease: 14,455
   
• Spinal fusion for back pain: 13,541
   
• Inferior vena cava filter: 9,595
   
• Carotid endarterectomy: 3,667
   
• Renal stent: 1,891
   
• Knee arthroscopy: 1,596

"The Lown Institute is the first to measure rates of hospital overuse during the COVID-19 pandemic. Overuse, or low-value care, refers to medical services that offer little to no clinical benefit or are more likely to harm patients than help them. … From June to December 2020, with no vaccines available to vulnerable older adults, hospitals delivered low-value services to Medicare patients at rates similar to 2019," the new analysis says.

These are the Top 5 hospitals for avoiding overuse of eight low-value procedures and four low-value tests in the 2022 Lown Hospitals Index for Social Responsibility (the ranking is based on Medicare claims data from 2018 to 2020).

1. Highland Hospital, Rochester, New York

2. Natividad Medical Center, Salinas, California

3. Kalispell Regional Medical Center, Kalispell, Montana

4. Beth Israel Deaconess Medical Center, Boston

5. Lahey Hospital & Medical Center, Burlington, Massachusetts

These are the Top 5 states ranked by average performance on avoiding overuse of eight low-value procedures and four low-value tests in the 2022 Lown Hospitals Index for Social Responsibility (the ranking is based on Medicare claims data from 2018 to 2020).

1. Oregon

2. Maine

3. Vermont

4. Minnesota

5. South Dakota

Dimensions of unnecessary care

There are three primary negative consequences of unnecessary surgeries, Vikas Saini, MD, president of the Lown Institute, told HealthLeaders.

• "First and foremost, procedures of any kind carry risk, and this is particularly true for procedures that are unlikely to benefit the patient. The risk of complications, side effects, and harms is one of the consequences of unnecessary surgeries. Fortunately, most surgeries and procedures have complication rates in the single digits. So, most of the time you are going to be fine, but the fact is if you start multiplying unnecessary surgeries by large numbers of people there will be unnecessary harms."
   
• "Second, there is the cost. Quite often, people with insurance do not face costs for unnecessary surgeries, but sometimes they do. There can be copayments, costs for complications, costs for new medications, and costs associated with follow-up care. Mostly, the costs are felt at the systemic level. In that sense, we all are paying for unnecessary surgeries."
   
• "Third is the classic question of opportunity costs. If you can free up capacity to do other procedures that have more value, you can generate a bigger bang for the buck. Those procedures are being crowded out by low-value procedures. If you imagine a world where we are trying to be efficient and have a healthcare system that does not cost too much, then you want to be using doctors' time, nurses' time, and all staff time for its highest purpose."

In the first year of the pandemic, the rate of unnecessary surgeries initially fell then returned to pre-pandemic proportions, Saini said.

"When the pandemic first hit, many people speculated that it would cause a drop in unnecessary care because the pandemic caused a drop in all care. When we looked at this, what we found was that the factor that caused a drop in unnecessary care was the shutdown. In April and May 2020, rates of medical care in general plummeted, and the rates of unnecessary care also plummeted. After the shutdown as business returned to normal, the rates of unnecessary care came back, and eventually they returned to 2019 levels," he said.

The pandemic trends for unnecessary surgeries show that several change factors are needed to address the problem, Saini said. "The experience of the pandemic tells us it is going to take something stronger than exhortation or pointing to a study that shows a surgery is unnecessary to reduce unnecessary care. As with all change in a complex system such as healthcare, it is going to take multiple things all at once to reduce unnecessary surgeries."

For now, unnecessary surgeries are widely embedded in U.S. healthcare, he said. "Unnecessary surgeries are entrenched because they are part of the fabric of modern medical practice. … Among the Top 20 U.S. News & World Report recognized hospitals, some do well, and some do not do well. The fact that some of the top hospitals do unnecessary surgeries shows that it is entrenched."

Related: Physicians Say up to 30% of Treatment Unnecessary