When Covid-19 struck in early 2020 many hospitals and hospital outpatient clinics began to scale back or stopped performing non-emergency procedures. The idea was to avoid putting patients at risk of Covid or to reserve capacity for those with Covid. At least that was the theory and partly why hospitals were provided federal bailout funds when their usual business model was interrupted by the pandemic. Nonetheless, the Lown Institute analyzed Medicare claims data to see if hospitals were still performing low-value procedures between March and December 2020. The think tank found that despite the pandemic, hospitals performed more than 100,000 largely unnecessary procedures that were either of little clinical value or more likely to harm patients than benefit them. Coronary stents and back surgeries were among the most-performed surgeries of questionable value.
A total of 106,474 procedures identified:
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Stents for stable coronary disease: 45,176
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Vertebroplasty for osteoporosis: 16,553
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Hysterectomy for benign disease: 14,455
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Spinal fusion for back pain: 13,541
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Inferior vena cava filter: 9,595
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Carotid endarterectomy: 3,667
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Renal stent: 1,891
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Knee arthroscopy: 1,596
It was not just rogue hospitals or second or third tier community hospitals with high rates of low-value procedures. Top U.S. hospitals were often the worst offenders:
Among the “U.S. News & World Report” 20 top-ranked hospitals, all had rates of coronary stent procedures above the national average in what the Lown Institute called “overuse.” Four had at least double the national average, including the Cleveland Clinic, Houston Methodist Hospital, Mt. Sinai and Barnes Jewish Hospital. The procedures and overuse criteria were based on previous Lown research.
The American Hospital Association took issue with Lown’s assessment, saying:
“Lown may define these services as ‘low value,’ but they can be of tremendous value to the patients who receive them,”
It added that procedures are determined by physicians based on an evaluation of the patient’s medical needs.