Medicare paid for 200K unneeded back surgeries: Study
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U.S. hospitals performed more than 200,000 unnecessary back surgeries on older adults that cost taxpayers $1.9 billion, according to a new analysis of Medicare and Medicare Advantage claims data.
Why it matters: The findings from the Lown Institute track with earlier studies but come as Medicare administrators step up scrutiny of low-value services that often have limited effectiveness, by using clinical reviews and AI.
- Back surgeries often are needed for patients with herniated discs, stenosis and injuries from accidents but aren't necessarily better than nonsurgical alternatives for patients suffering from pain caused by aging.
- Lown said that's particularly the case for vertebroplasty, a common procedure that involves injecting bone cement into cracked vertebra to relieve pain.
By the numbers: An average of 13% of spinal fusions and laminectomies — a procedure to relieve pressure on the spinal cord — met criteria for overuse, meaning the patients weren't diagnosed for conditions such as trauma, scoliosis or a herniated disc.
- The average vertebroplasty overuse rate was 10%. The analysis deemed the procedure unnecessary for patients with spinal fractures caused by osteoporosis and excluded people with diagnoses like bone cancer or myeloma.
- There was widespread variation in overuse, even among hospitals in the same state. For example, Lown found 7.4% of spinal fusions at WellSpan York Hospital in Pennsylvania met criteria for overuse while the rate at Mount Nittany Medical Center was 57.2%.
- California, Florida, Texas and Pennsylvania had the highest volume of spinal fusion overuse, with at least 5,000 unnecessary procedures done in each state.
- Texas, Florida and Ohio had the highest volume of vertebroplasty overuse, with at least 6,000 unnecessary procedures done in each state.
Lown relied on Medicare fee-for-service data from 2021-2023 and Medicare Advantage claims from 2020-2022.
- An American Hospital Association spokesperson said the analysis and previous Lown findings on unnecessary back surgeries were flawed and didn't take into account factors like physicians' judgment.
- "Evaluating only claims data for Medicare patients without reviewing each patient's full medical history, failing to include a more comprehensive patient population and making broad claims about what is or is not a necessary procedure continue to be serious flaws with this analysis," the spokesperson said.
