Medicare Paid for More Than 200,000 Unnecessary Procedures Over Three Years, Costing Approximately $2 Billion
“In spinal surgery, as with other fields of medicine, physicians routinely overlook evidence to make exceptions, sometimes at shockingly high rates. This type of waste in Medicare is costly, both in terms of spending, and in risk to patients.”
– Vikas Saini, M.D., President, Lown Institute
Every eight minutes an unnecessary back surgery is performed on an older adult, putting thousands of patients at risk of a negative outcome and increasing Medicare spending, according to a new analysis from the Lown Institute, an independent think tank.
Researchers examined hospital data for common back surgeries, including spinal fusion, laminectomy, and vertebroplasty, for which clinical trials have repeatedly shown lack of benefit for certain patients. Patients with low-back pain caused by aging (excluding cases with neurologic symptoms, trauma, or structural abnormalities) receive little to no benefit from spinal fusion or laminectomy. Patients with spinal fractures caused by osteoporosis (excluding cases with bone cancer, myeloma, or hemangioma) receive little to no benefit from vertebroplasty.
More than 200,000 procedures met criteria for overuse and are estimated to have cost Medicare around $2 billion over a three-year period.
“We trust that our doctors make decisions based on the best available evidence, but that’s not always the case,” said Vikas Saini, MD, president of the Lown Institute. “In spinal surgery, as with other fields of medicine, physicians routinely overlook evidence to make exceptions, sometimes at shockingly high rates. This type of waste in Medicare is costly, both in terms of spending, and in risk to patients.”
Michigan Overuse Rates
The average overuse rates nationwide were 14% for spinal fusions/laminectomy and 11% for vertebroplasty. In Michigan, the report found, there were a total of 7,857 “overuse procedures” during the time period reviewed (3,679 spinal fusion/laminectomy, 4,178 vertebroplasty). The Michigan rates compare to the national average as follows:
- Spinal Fusion/Laminectomy Overuse Rate: 14.8% (higher than the national average)
- Vertebroplasty Overuse Rate: 9.5% (lower than the national average
Methodology
Hospital overuse was measured using Medicare fee-for-service and Medicare Advantage claims data for three years of the most recently available data (2020-2022 for fee-for-service and 2019-2021 for Medicare Advantage).
Spinal fusion and/or laminectomy was defined as overuse for patients with low-back pain if they did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Spinal fusion-only cases were not considered overuse for patients with stenosis with neural claudication and spondylolisthesis. Laminectomy-only cases were not considered overuse for patients with stenosis who had neural claudication. Vertebroplasty was defined as overuse for patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma, or hemangioma.
The cost of low-value back surgeries was calculated using Medicare’ procedure price lookup tool for outpatient procedures, and the average Diagnosis Related Group (DRG) cost from Medicare claims for inpatient procedures. Learn more about the methodology. The report can be found here.
Source: Lown Institute Press Release, “Unnecessary back surgeries cost Medicare up to $600 million annually,” November 14, 2024
