Unnecessary back surgeries cost Medicare $1.9 billion in three years

Physicians performed more than 200,000 unnecessary back surgeries on older adults over a three-year period, costing Medicare $1.9 billion over that time, according to new analysis from the Lown Institute.

The surgeries took place despite medical research showing they provide little to no clinical benefit and come with serious risks, analysts said. 

Complications of spinal fusion, one of the procedures studied, can occur in up to 18% of patients and include the risk of developing infection, blood clots, stroke, pneumonia, heart and lung problems, and, in some cases, death.

“Like everyone in America, older people with back pain deserve safe, evidence-based care that doesn’t waste taxpayer dollars,” said Dr. Vikas Saini, president of the Lown Institute. “Reducing unnecessary procedures, particularly invasive ones that carry grave risks, is a moral imperative. Physicians, policymakers, and hospitals must act to protect their constituents and patients.”

WHAT'S THE IMPACT 

Rates of overuse for spinal fusion – a procedure that joins two or more bones in the spine together – varied widely among hospitals in the same state. The report cited as examples two providers in Pennsylvania. At Wellspan York Hospital in Pennsylvania, 7.4% of spinal fusions met criteria for overuse, while the rate at Mount Nittany Medical Center was 57.2%.

Rates of overuse for vertebroplasty, a procedure used to treat painful spinal compression fractures, also varied widely among hospitals in the same state. For instance, no patients with osteoporotic spinal fracture at MetroHealth Medical Center in Ohio received a medically unnecessary vertebroplasty, compared to more than 50% of patients at Kettering Health Miamisburg, according to the report.

The Lown Institute’s findings come as the Centers for Medicare and Medicaid Services is launching efforts targeting overuse of medical services, like its introduction of the WISeR (Wasteful and Inappropriate Service Reduction) Model. 

WISeR’s list of 17 services includes vertebroplasty, a surgery that Lown’s study confirms is extensively overused on patients.

“The fact that CMS is launching an effort to curb overuse is a welcome and important step toward improving healthcare safety and reducing unnecessary federal spending,” said Saini.

THE LARGER TREND 

Hospital overuse was measured using Medicare fee-for-service and Medicare Advantage claims data for three years of the most recently available data (2021-2023 for fee-for-service and 2020-2022 for Medicare Advantage). 

Spinal fusion and/or laminectomy is defined as overuse for patients with low-back pain who did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. 

Vertebroplasty is defined as overuse for patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma or hemangioma.