Hospital Overuse in Covid - Lown Institute Hospital Index

Low-Value procedures, by volume

Hospitals delivered more than 100,000 low-value procedures in the first ten months of Covid-19. Below is the breakdown of low-value services by procedure.

Procedure	Number of low-value procedures, March – Dec 2020
Stents for stable coronary disease	45,176
Vertebroplasty for osteoporosis	16,553
Hysterectomy for benign disease	14,455
Spinal fusion for back pain	13,541
IVC filter	9,595
Carotid endarterectomy	3,667
Renal stent	1,891
Knee arthroscopy	1,596
TOTAL	106,474

Unnecessary coronary stents

Hospitals performed more than 45,000 coronary stents from March-December 2020 that met criteria for overuse. Coronary stenting, in which a wire mesh stent is used to open a blocked artery, has shown to be no more beneficial than medication therapy alone for patients with stable coronary disease.

What’s at stake?

Risks of stenting include blood clots that can lead to stroke or heart attack, injury to the heart arteries, infection at the catheter site, allergic reaction to the dye or contrast used, and kidney damage from the dye or contrast. Additionally, every 1000 low-value coronary stents performed in hospitals is associated with 9 hospital-acquired conditions or patient safety events (not counting the risk of contracting COVID-19). Our health system would also save an estimated $500 million if we didn’t put coronary stents into people without symptoms.

Which hospitals placed the most low-value stents in 2020?

Among general hospitals (not specialty hospitals) the worst offenders for unnecessary stenting were NYU Langone Medical Center, St Francis Hospital, and Mt. Sinai Hospital in the New York City area, and Scripps Memorial Hospital and Cedars-Sinai Medical Center in Southern California. For each of these hospitals, low-value stents made up at least one third of all of the stents placed in 2020.

Table: These 19 hospitals performed at least 200 low-value coronary stents in 2020. All of these hospitals had a rate of overuse over 30%.

Hospital	State	City	Low-value coronary stents	All coronary stents	Rate of overuse
NEW YORK UNIVERSITY LANGONE MEDICAL CENTER	NY	NEW YORK	380	1025	37%
ST FRANCIS HOSPITAL – THE HEART CENTER	NY	ROSLYN	368	1109	33%
MOUNT SINAI HOSPITAL	NY	NEW YORK	333	788	42%
SCRIPPS MEMORIAL HOSPITAL LA JOLLA	CA	LA JOLLA	309	737	42%
CEDARS-SINAI MEDICAL CENTER	CA	LOS ANGELES	303	787	39%
SANFORD USD MEDICAL CENTER	SD	SIOUX FALLS	282	682	41%
JERSEY SHORE UNIVERSITY MEDICAL CENTER	NJ	NEPTUNE	264	716	37%
UF HEALTH LEESBURG HOSPITAL	FL	LEESBURG	262	554	47%
ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL	NJ	NEW BRUNSWICK	244	614	40%
MORRISTOWN MEDICAL CENTER	NJ	MORRISTOWN	244	701	35%
ADVENTHEALTH ORLANDO	FL	ORLANDO	234	529	44%
NEW YORK-PRESBYTERIAN HOSPITAL	NY	NEW YORK	225	703	32%
MORTON PLANT MEASE HEALTHCARE COUNTRYSIDE	FL	SAFETY HARBOR	218	420	52%
BAKERSFIELD HEART HOSPITAL	CA	BAKERSFIELD	217	412	53%
METHODIST HOSPITAL	TX	SAN ANTONIO	209	669	31%
KAWEAH HEALTH MEDICAL CENTER	CA	VISALIA	208	476	44%
NORTHWEST TEXAS HOSPITAL	TX	AMARILLO	204	347	59%
CLEVELAND CLINIC	OH	CLEVELAND	203	465	44%
UT HEALTH EAST TEXAS TYLER REGIONAL HOSPITAL	TX	TYLER	201	542	37%

Unnecessary coronary stents, U.S. NEWS HOSPITALS

All 20 hospitals on the U.S. News Honor Roll had rates of coronary stent overuse above the national average in 2020. Four hospitals (Cleveland Clinic, Houston Methodist Hospital, Mount Sinai Hospital, and Barnes Jewish Hospital) had overuse rates at least double the national average.

U.S. News rank	Hospital	State	Low-value coronary stents	All coronary stents	Overuse Rate
1	Mayo Clinic Hospital Rochester	MN	142	535	27%
2	Cleveland Clinic	OH	203	465	44%
3	Ronald Reagan UCLA Medical Center	CA	72	177	41%
4	The Johns Hopkins Hospital	MD	55	187	29%
5	Massachusetts General Hospital	MA	120	395	30%
6	Cedars-Sinai Medical Center	CA	303	787	39%
7	New York-Presbyterian Hospital	NY	225	703	32%
8	NYU Langone Hospitals	NY	380	1025	37%
9	UCSF Medical Center	CA	61	151	40%
10	Northwestern Memorial Hospital	IL	62	241	26%
11	Michigan Medicine	MI	93	256	36%
12	Stanford Health Care	CA	83	218	38%
13	Hospital of University of Pennsylvania	PA	35	100	35%
14	Brigham and Women’s Hospital	MA	83	328	25%
15	Mayo Clinic Hospital	AZ	33	138	24%
16	Houston Methodist Hospital	TX	194	436	44%
17	Mount Sinai Hospital	NY	333	788	42%
17	Barnes Jewish Hospital	MO	172	405	42%
18	Rush University Medical Center	IL	49	126	39%
19	Vanderbilt University Medical Center	TN	94	372	25%
	National Average				21%

Top 50 hospitals, AVOIDING OVERUSE

These are the top 50 hospitals for avoiding overuse on the 2022 Lown Hospitals Index for Social Responsibility. This ranking includes overuse of eight common low-value procedures and four low-value tests. Data for these rankings comes from 2018-2020 Medicare claims.

Rank	Name	State
1	HIGHLAND HOSPITAL	NY
2	NATIVIDAD MEDICAL CENTER	CA
3	KALISPELL REGIONAL MEDICAL CENTER	MT
4	BETH ISRAEL DEACONESS MEDICAL CENTER	MA
5	LAHEY HOSPITAL & MEDICAL CENTER, BURLINGTON	MA
6	ST LUKE’S REGIONAL MEDICAL CENTER	ID
7	TUFTS MEDICAL CENTER	MA
8	MAINE MEDICAL CENTER	ME
9	UNIV. OF VERMONT – FLETCHER ALLEN HEALTH CARE	VT
10	STRONG MEMORIAL HOSPITAL	NY
11	MARY HITCHCOCK MEMORIAL HOSPITAL	NH
12	METROHEALTH SYSTEM	OH
13	HARBORVIEW MEDICAL CENTER	WA
14	UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY	WI
15	BOONE COUNTY HEALTH CENTER	NE
16	UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC	OH
17	NORTHWESTERN MEDICAL CENTER INC	VT
18	BOZEMAN HEALTH DEACONESS HOSPITAL	MT
19	AMERY HOSPITAL & CLINIC	WI
20	CHASE COUNTY COMMUNITY HOSPITAL	NE
21	THE MIRIAM HOSPITAL	RI
22	GOOD SAMARITAN REGIONAL MEDICAL CENTER	OR
23	ESKENAZI HEALTH	IN
24	PENDER COMMUNITY HOSPITAL	NE
25	MID COAST HOSPITAL	ME
26	UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS	MA
27	JACOBI MEDICAL CENTER	NY
28	UNIVERSITY OF MISSOURI HEALTH CARE	MO
29	FRANCISCAN HEALTH INDIANAPOLIS	IN
30	CENTRA HEALTH – LYNCHBURG GEN HOSPITAL	VA
31	ESSENTIA HEALTH ST MARY’S MEDICAL CENTER	MN
32	CONTRA COSTA REGIONAL MEDICAL CENTER	CA
33	UNIVERSITY OF COLORADO HOSPITAL AUTHORITY	CO
34	ZUCKERBERG SAN FRANCISCO GENERAL HOSP & TRAUMA CTR	CA
35	MARSHFIELD MEDICAL CENTER	WI
36	UNIVERSITY OF UTAH HOSPITALS AND CLINICS	UT
37	NANTUCKET COTTAGE HOSPITAL	MA
38	REPUBLIC COUNTY HOSPITAL	KS
39	CHATHAM HOSPITAL INC	NC
40	COZAD COMMUNITY HOSPITAL	NE
41	ELLIOT HOSPITAL	NH
42	SAINT ALPHONSUS REGIONAL MEDICAL CENTER	ID
43	GLACIAL RIDGE HOSPITAL	MN
44	ASCENSION COLUMBIA ST MARY’S HOSPITAL MILWAUKEE	WI
45	NORTH MEMORIAL HEALTH HOSPITAL	MN
46	VANDERBILT UNIVERSITY MEDICAL CENTER	TN
47	REGIONS HOSPITAL	MN
48	HENNEPIN COUNTY MEDICAL CENTER	MN
49	MILTON S HERSHEY MEDICAL CENTER	PA
50	LEGACY GOOD SAMARITAN MEDICAL CENTER	OR

BOTTOM 50 hospitals, AVOIDING OVERUSE

These are the 50 lowest ranked hospitals for Avoiding Overuse on the 2022 Lown Hospitals Index for Social Responsibility. This ranking includes overuse of eight common low-value procedures and four low-value tests. Data for these rankings comes from 2018-2020 Medicare claims.

Rank	Name	State
3191	RICHARDSON MEDICAL CENTER	LA
3190	GREAT RIVER MEDICAL CENTER	AR
3189	BARROW REGIONAL MEDICAL CENTER	GA
3188	LAKESIDE MEDICAL CENTER	FL
3187	CUMBERLAND COUNTY HOSPITAL	KY
3186	UF HEALTH LEESBURG HOSPITAL	FL
3185	CAPE FEAR VALLEY HOKE HOSPITAL	NC
3184	DESERT VIEW HOSPITAL	NV
3183	SAN GORGONIO MEMORIAL HOSPITAL	CA
3182	MOREHOUSE GENERAL HOSPITAL	LA
3181	BAPTIST HEALTH – VAN BUREN	AR
3180	MEMORIAL HOSPITAL MIRAMAR	FL
3179	NORTHWEST MEDICAL CENTER	AL
3178	HOMESTEAD HOSPITAL	FL
3177	ST VINCENT’S CHILTON	AL
3176	UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER	GA
3175	PALISADES MEDICAL CENTER	NJ
3174	CHRISTUS SPOHN HOSPITAL ALICE	TX
3173	HELENA REGIONAL MEDICAL CENTER	AR
3172	WEST KENDALL BAPTIST HOSPITAL	FL
3171	ADAMS COUNTY REGIONAL MEDICAL CENTER	OH
3170	DESOTO MEMORIAL HOSPITAL	FL
3169	MCLEOD MEDICAL CENTER – DILLON	SC
3168	CROSSGATES RIVER OAKS HOSPITAL	MS
3167	SPRING VALLEY HOSPITAL MEDICAL CENTER	NV
3166	COLUMBUS COMMUNITY HOSPITAL	TX
3165	LARKIN COMMUNITY HOSPITAL	FL
3164	VALLEY WEST COMMUNITY HOSPITAL	IL
3163	MERIT HEALTH MADISON	MS
3162	BAPTIST MEDICAL CENTER EAST	AL
3161	PALO VERDE HOSPITAL	CA
3160	PANA COMMUNITY HOSPITAL	IL
3159	HARDIN MEDICAL CENTER	TN
3158	SOUTHERN TENNESSEE REGIONAL HEALTH SYSTEM PULASKI	TN
3157	MEMORIAL HERMANN SUGAR LAND HOSPITAL	TX
3156	ADVENTIST HEALTHCARE FORT WASHINGTON MEDICAL CTR	MD
3155	NORTH TEXAS MEDICAL CENTER	TX
3154	LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS	FL
3153	TUG VALLEY ARH REGIONAL MEDICAL CENTER	KY
3152	ANDERSON REGIONAL MEDICAL CTR	MS
3151	UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER	OH
3150	CHI ST LUKES HEALTH MEMORIAL LIVINGSTON	TX
3149	OAKBEND MEDICAL CENTER	TX
3148	ST LUKE’S HOSPITAL AT THE VINTAGE	TX
3147	UT HEALTH EAST TEXAS QUITMAN HOSPITAL	TX
3146	PIEDMONT WALTON HOSPITAL	GA
3145	SOUTHERN TENNESSEE REGIONAL HEALTH SYSTEM LAWRENCE	TN
3144	STEWARD CORAL GABLES HOSPITAL	FL
3143	VILLAGES REGIONAL HOSPITAL, THE	FL
3142	PANOLA MEDICAL CENTER	MS

U.S. State Ranking

U.S. states ranked by average performance on Avoiding Overuse on the 2022 Lown Hospitals Index for Social Responsibility. This ranking includes overuse of eight common low-value procedures and four low-value tests. Data for these rankings comes from 2018-2020 Medicare claims.

Rank	State
1	Oregon
2	Maine
3	Vermont
4	Minnesota
5	South Dakota
6	Colorado
7	Massachusetts
8	Washington
9	Nebraska
10	Montana
11	Rhode Island
12	New Hampshire
13	Wisconsin
14	North Dakota
15	Utah
16	Idaho
17	Washington, DC
18	Connecticut
19	Hawaii
20	Alaska
21	Iowa
22	Wyoming
23	New York
24	Michigan
25	California
26	Missouri
27	Kansas
28	Pennsylvania
29	Virginia
30	Indiana
31	New Mexico
32	Ohio
33	Delaware
34	Oklahoma
35	North Carolina
36	Illinois
37	New Jersey
38	South Carolina
39	Arizona
40	Georgia
41	Louisiana
42	Arkansas
43	West Virginia
44	Tennessee
45	Maryland
46	Nevada
47	Texas
48	Kentucky
49	Florida
50	Mississippi
51	Alabama

methodology, Overuse during covid

The Lown Institute used data from the 100% Medicare claims database from January – December 2020 to evaluate overuse of eight common low-value services. Procedures and overuse criteria were based on our previously published research into measurement of low-value care at hospitals. Procedures included were:

Arthroscopic knee surgery – Surgery to remove damaged cartilage or bone in the knee using an arthroscope (tiny camera). Defined as overuse for patients with osteoarthritis or “runner’s knee” (damaged cartilage). Excluding patients with meniscal tear.

Carotid endarterectomy – Procedure to remove plaque buildup from a carotid (neck) artery in a patient to prevent stroke. Considered overuse when performed on female patients without stroke symptoms or history of stroke.

Coronary artery stenting – Also known as percutaneous coronary intervention. Procedure to place a stent or balloon in a coronary artery using a catheter. Also includes procedures where the artery is opened but a stent is not inserted. Defined as overuse when performed on patients with stable heart disease (not having a heart attack or unstable angina). Excluding patients with past diagnosis of unstable angina or heart attack within the past two weeks, or any procedures performed in the emergency department.

Hysterectomy – Procedure to remove the uterus. Considered overuse for patients without a diagnosis of cancer or carcinoma in situ.

Inferior Vena Cava (IVC) filter – Procedure to place a filter (a medical device) in the large vein in the abdomen to prevent blood clots from moving to the lungs. Considered overuse for all patients except those with history of multiple pulmonary embolism.

Renal artery stenting – Procedure to place a stent or balloon in the renal (kidney) artery. Considered overuse for patients with high blood pressure or plaque buildup in the artery. Excluding patients that had diagnosis of fibromuscular dysplasia of the renal artery (abnormal twisting of the blood vessels).

Spinal fusion/laminectomy – Procedure to fuse vertebrae together (spinal fusion) or remove part of a vertebra (laminectomy). Defined as overuse for patients with low-back pain, excluding patients with radicular symptoms, trauma, herniated disc, discities, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis.

Vertebroplasty – Procedure to inject cement into the vertebrae to relieve pain from spinal fractures. Considered overuse for patients with spinal fractures caused by osteoporosis. Excluding patients with bone cancer, myeloma, or hemangioma.

methodology, overuse ranking

In addition to the analysis of hospital overuse in Covid-19 above, the Lown Institute also ranked the top and bottom 50 hospitals on their avoidance of low-value tests and procedures. This ranking includes the eight procedures above, plus and four imaging services. These rankings use data from 2018-2020 Medicare claims.

Only hospitals with the capacity to do four or more services were ranked. Hospitals’ overuse score for each service is based on the rate of overuse as well as the volume of overuse. The overuse composite ranking is based on all services, with more weight placed on the services that make up the larger share of overuse.

IMAGING SERVICES

Carotid artery imaging for fainting – A test to screen for carotid (neck) artery disease. Considered overuse for patients where syncope (fainting) is the primary diagnosis, and there is no history of syncope in the past two years. Excluding patients with stroke or mini-stroke, retinal vascular occlusion/ischemia, or nervous and musculoskeletal symptoms.

EEG for fainting – A test of the electrical activity of the brain. Considered overuse for patients where syncope (fainting) is the primary diagnosis, and there is no history of syncope in the past two years.

EEG for headache – A test of the electrical activity of the brain. Defined as overuse for patients with headache as the primary diagnosis on the claim and no history of headache in the past two years. Excluding patients with epilepsy and recurrent seizures, convulsions, and abnormal involuntary movements.

Head imaging for fainting – Considered overuse for patients where syncope (fainting) is the primary diagnosis, and there is no history of syncope in the past two years. Excluding patients with epilepsy or convulsions, cerebrovascular diseases, head or face trauma, altered mental status, nervous and musculoskeletal system symptoms, and history of stroke.

PROCEDURES