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

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.