Medicare spent $2B on unneeded back surgeries
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Hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries in the U.S. over three years, according to a new analysis.
Why it matters: Roughly $2 billion was spent on the "low value" procedures while patients were put at risk of poor outcomes, researchers from the Lown Institute wrote.
What they found: The researchers looked at Medicare fee-for-service and Medicare Advantage claims for common back surgeries, including spinal fusion, laminectomy, and vertebroplasty, over three-year periods.
- The most recently available data for fee-for-service was from 2020 to 2022 and from 2019 to 2021 for Medicare Advantage.
- Roughly 14% of spinal fusions and laminectomies — which are done to relieve pressure on the spinal cord — met criteria for overuse, meaning patients with low-back pain did not have certain diagnoses, such as trauma, a herniated disc or scoliosis.
- 11% of patient visits for osteoporotic fracture resulted in an unnecessary vertebroplasty, which involves injecting cement into a cracked or broken spinal bone to relieve pain. The procedure was considered unnecessary for patients with spinal fractures caused by osteoporosis, excluding certain others such as those with bone cancer or myeloma.
Between the lines: Overuse rates varied greatly — from less than 1% to more than 50% — between hospitals, the authors pointed out.
- New Hampshire, Iowa, Massachusetts, and Pennsylvania had the highest overuse rates of spinal fusion/laminectomy.
- That variability, while not surprising, is frustrating in its persistence, Vikas Saini, president of the Lown Institute, told Axios.
- For instance, it's been more than a decade since data showed that the vast majority of vertebroplasties don't work but it seems many doctors "still haven't gotten the memo," he said.
"Where you trained and what the norm is for you is often the bigger determinant [of surgery] compared to what the evidence is," he said.
- Shining a spotlight on just how common that is a step toward addressing the waste, he said.
