Southern and for-profit hospitals more frequently deliver unnecessary tests and procedures: analysis

By reviewing Medicare claims for 12 services, the Lown Institute ranked more than 3,000 U.S. hospitals on how often they delivered unnecessary care—such as hysterectomies for benign disease—to older patients. (Getty/SARINYAPINNGAM)

Overuse of unnecessary healthcare services was most common among for-profit hospitals, nonteaching hospitals and those located in the southern U.S., according to a new review of Medicare claims conducted by the Lown Institute.

The study found more than 1.3 million low-value tests and procedures delivered by 3,351 U.S. hospitals between Jan. 1, 2015, and Dec. 31, 2017—a rate of one such unnecessary service delivered to an older adult every 80 seconds.

Hysterectomies for benign disease were among the worst offenders, with 64% of those conducted across the nation meeting the criteria for overuse. Similarly, 44% of carotid endarterectomies (a procedure removing plaque from a neck artery) and 24% of coronary stent procedures were also found to be unnecessary.

Diagnostic imaging services also made up a substantial portion of overuse identified during the study period. Here, the researchers spotted nearly 380,000 instances of unnecessary head imaging for fainting—the single highest volume service included in the analysis—and more than 130,000 instances of unnecessary neck artery imaging for fainting.

Estimates suggest that overuse contributes $75.7 billion to $101.2 billion to wasted U.S. healthcare spending annually,” the researchers wrote in a JAMA Network Open paper describing their findings. “Although clinicians are responsible for ordering tests and treatments, their practice patterns may be influenced by hospital policies and culture. Hospital-level interventions to reduce overuse exist, but to measure and compare their success, a hospital-level measure is required.”

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With this in mind, the researchers compared the rates of these and seven other low-value services across different hospital characteristics and released an accompanying breakdown of best- and worst-performing hospitals by various categories.

The analysis found that larger hospitals, major teaching hospitals and nonprofits were overall more likely to avoid overuse.

It also revealed regional differences in overuse, with New England and the Pacific Northwest earning high marks. The South, meanwhile, housed 41 of the 50 lowest-performing hospitals as Florida alone claimed five of the bottom 10 hospitals.

The Lown Institute noted in a statement that its list of the top 100 hospitals avoiding overuse was bereft of major providers named to U.S. News’ most recent Best Hospitals Honor Roll. Of these, only the Cleveland Clinic landed on Lown’s list at No. 58.

“Overuse in American hospitals is a pervasive problem that needs to be addressed,” Vikas Saini, M.D., president of the Lown Institute, said in a statement. “Hospitals want to do better and these objective measures of performance can help them move forward.”

Headlining Lown’s overall ranking of overuse avoiders, in descending order, were Scott County Hospital (Kansas), Beth Israel Deaconess Medical Center (Massachusetts), West River Regional Medical Center-CAH (North Dakota), Highland Hospital (New York) and Mayo Clinic Health System – Lake City (Minnesota).

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Among major teaching hospitals, Lown’s top performers, in descending order, were Beth Israel Deaconess Medical Center (Massachusetts), Maine Medical Center (Maine), Mary Hitchcock Memorial Hospital (New Hampshire), UMass Memorial Medical Center/University Campus (Massachusetts) and Tufts Medical Center (Massachusetts).

In addition to serving as a tool for hospitals’ self-evaluation, the researchers wrote that these hospital-level comparisons or a similar methodology could be used by payers to influence decision-making.

“For example, payers such as CMS might consider structuring financial incentives for reducing overuse around specific hospital factors in our data,” they wrote. “Our cluster analyses might also point to ways for payers to target incentives for reducing particular types of overuse; diagnostic testing, for example, is already low in major teaching hospitals but higher in others.”

Unnecessary care has proven itself to be a persistent and costly issue for the industry. A similar analysis of insurance claims data from Washington state found that more than 600,000 of the 1.3 million patients received a treatment they didn’t need within a single year, representing an estimated $282 million in unnecessary costs

More recently, a claims review published in this week’s Health Affairs suggested patients’ odds of receiving an inappropriate MRI referral increased when their physician became employed by a hospital. With most of those procedures being conducted at the same hospital at which the referring physician was employed, the researchers said their findings were evidence of hospital-physician integration as a potential driver of unnecessary care.