Medical Overuse

Unnecessary Back Surgery

Older Americans put at risk while billions in Medicare funds wasted

LAUNCH EVENT: Join us on Thursday, November 14 at 1:00PM ET for a panel discussion featuring guest panelists Claire Brockbank, director of policy and strategy for 32BJ Health Fund; Dr. Sohail Mirza, orthopedic surgeon and professor at Dartmouth College; and Dr. Vikas Saini, president of the Lown Institute.

The Lown Institute Hospitals Index is the first to evaluate how well individual hospitals avoid overuse of common low-value tests and procedures. The Institute measured overuse of spinal fusion/laminectomy and vertebroplasty at hospitals with the capacity to perform the procedure using Medicare fee-for-service (2020-2022) and Medicare Advantage (2019-2021) claims data.  (press release | methodology)

Key Takeaways

  • Over three years, U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries. That’s one low-value back procedure every eight minutes.
  • These low-value back procedures cost Medicare about $2 billion in total over three years.
  • On average, 14% of spinal fusions/laminectomies met criteria for overuse, with individual hospital overuse rates ranging from less than 1% to more than 50%.
  • On average, 11% of patient visits for osteoporotic fracture resulted in an unnecessary vertebroplasty, with individual hospital rates of overuse ranging from zero to 50%.
  • New Hampshire, Iowa, Massachusetts, and Pennsylvania had the highest overuse rates of spinal fusion/laminectomy with rates over 18%. Arkansas, Kansas, Oklahoma, and Nevada had the highest overuse rates of vertebroplasty, with rates over 16%.
  • U.S. News Honor Roll hospitals had varied performance. At Cleveland Clinic fewer than 1% of patient visits with osteoporotic fracture resulted in an unnecessary vertebroplasty, compared to nearly 20% at Mayo Clinic Phoenix.
  • A total of 3,454 physicians performed a measurable number of low-value back surgeries. Over three years, these physicians received a total of $64 million from device and drug companies for consulting, speaking fees, meals, and travel, according to Open Payments data analyzed by Conflixis.

Media inquiries should be directed to Aaron Toleos, vice president of communications for the Lown Institute, at atoleos@lowninstitute.org.