Hospitals called out for performing too many low-value tests and procedures

surgerylown-300x196When it comes to hospitals performing low-value tests or procedures and putting older patients at increased risk, Dixie may have little to whistle about.

The Lown Institute, a respected and nonpartisan think tank that says it “believes a radically better American health system is possible,” has published a new hospital index that puts dozens of southern institutions in a dubious light.

That’s because institute researchers scrutinized federal Medicare records on more than 1.3 million fee-for-services provided to older patents at more than 3,300 hospitals nationwide. They reported in findings published in an online part of the Journal of the American Medical Association that “hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse” of health care services.

Patients may wish to take special note of a dozen or so procedures that the expert researchers focused on as “overuse,” meaning too common and unnecessary, as shown in numerous previous studies. These include:

  • hysterectomy for benign disease
  • placement of coronary stents for stable heart disease
  • diagnostic tests like head imaging for fainting
  • and vertebroplasty, a procedure to inject cement into the spine, which has been found to be ineffective for osteoporosis-related fractures in numerous trials.

Based on its analysis, the Lown researchers had these key takeaways about hospitals and their patient treatment:

  • Every 80 seconds, a hospital in the U.S. delivers a low-value test or procedure to an older adult, putting hundreds of thousands at risk of harm
  • The South is home to 41 of the 50 lowest-performing hospitals, with five of the bottom ten located in Florida
  • Out of the 50 top performing hospitals, nine are in New England and ten in the Pacific Northwest, making those regions stand out at the top of the list.

The institute’s list of 50 worst and best performers may offer important information, among many factors, for patients to consider when choosing where to undergo medical treatment. Many of the poor performers are not hospitals with national rankings and reputations, though they may be strong in their regions. The overuse-data provides key information to the public about them, Lown president Vikas Saini, MD, told a reporter from the medical news site MedPage Today:

“[F]or the hospitals with the most overuse, ‘it appears there is a culture. The evidence that these procedures are not useful hasn’t penetrated or is being ignored’ … for someone who is having a heart attack, ‘a coronary stent is perfectly reasonable. But if someone has very stable angina that they’ve had for months and months and it’s not changing, a coronary stent is unnecessary. Full stop.’ At these lower ranked hospitals, the frequent use of unnecessary procedures is often ‘across the board, with cardiology, radiology, orthopedic surgery procedures … It’s not one specialty, and it does suggest there’s something going on in the atmosphere, or who the doctors are in a given place.’”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them by over-testing, over-diagnoses, misdiagnoses, and medical error. In the times before the coronavirus pandemic, researchers reported that medical errors claimed the lives of roughly 685 Americans per day — more people than died of respiratory disease, accidents, stroke and Alzheimer’s. This meant that medical errors ranked as the third leading cause of death in the U.S., behind only heart disease and cancer.

All medical interventions carry risks with them, and it is distressing that older patients, as the Lown researchers have found, face heightened chances for poor outcomes due to low-value tests and procedures. It is not helpful that health care providers in our current system get paid by the treatment or service, incentivizing them to increase the quantity and not necessarily the quality, safety, or affordability of care.

We have much work to do to improve our health care system, including by slashing at costly, unnecessary, and unhelpful medical services.

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