Over 200,000 Unnecessary Back Surgeries Costing Medicare $2 Billion: A Lown Institute Analysis
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Hospitals conducted over 200,000 unnecessary back surgeries in three years, according to the Lown Institute. These surgeries posed risks for patients and cost Medicare about $2 billion. The rate of unnecessary surgeries varied widely across hospitals, with some performing none while others exceeded 50% of procedures.
Analysis Methodology
Researchers analyzed Medicare claims data to evaluate three common but often unbeneficial procedures:
- Spinal fusion
- Laminectomy
- Vertebroplasty
Studies have shown that vertebroplasty offers little or no benefit for osteoporosis-related spinal fractures.
Surgeries were not counted as unnecessary if the patient had a valid diagnosis requiring surgery, such as scoliosis or bone cancer.
Key Findings
The average overuse rates were 14% for spinal fusion and laminectomy, varying between 1% and nearly 63% by hospital. For vertebroplasty, the average overuse rate was 11%, with rates ranging from 0% to 55.5%.
Additionally, 3,454 doctors performing unnecessary surgeries received $64 million from device and drug companies, highlighting potential conflicts of interest.
The analysis covered three years of Medicare claims data from 2020-2022 for Medicare fee-for-service and 2019-2021 for Medicare Advantage, examining hospitals with over 500 procedures.
Patient Risks
Fusion and laminectomy surgeries can lead to serious complications, including:
- Infection
- Blood clots
- Heart and lung issues
- Paralysis
- Stroke
- Death
Vertebroplasty may also cause complications such as bleeding and cement leakage, potentially leading to severe outcomes.
Unnecessary surgeries can create scar tissue and stiffness, often resulting in more surgeries. Dr. Sohail Mirza noted that once a patient undergoes back surgery, they may require further procedures.
Insurance Coverage
Despite the risks, surgeries not supported by evidence remain covered by Medicare and private insurers. Hospitals benefit financially from these surgeries, which can influence physician recommendations.
To combat unnecessary surgeries, Claire Brockbank from a health care fund emphasized reducing costs for physical therapy. She observed that quality in healthcare should go hand in hand with cost-effectiveness.
Conclusion
The analysis highlights the prevalence of unnecessary back surgeries and underscores the need for better patient education and a reevaluation of current surgical practices.