Rates of unnecessary procedures persisted through pandemic, study shows


Despite the risks posed by COVID-19, hospitals continued to perform eight common, low-value procedures during the first year of the pandemic at a rate similar to 2019, according to a Lown Institute analysis published Tuesday.

Between March and December 2020, hospitals performed more than 100,000 procedures on older patients that have been deemed overused, according to an analysis of Medicare claims data from 2018 through 2020.

These services, which are thought to offer little to no clinical benefit for patients and present additional risks, include hysterectomies for benign disease, coronary stents for stable heart disease and spinal fusions for lower-back pain.

Volume declined for necessary and unnecessary procedures alike because of pandemic-driven shutdowns in April and May 2020, said Dr. Vikas Saini, president of the Lown Institute. As COVID-19 restrictions eased and coronavirus infections rose, the volume of low-value care increased at the same time, nearly reaching pre-pandemic rates, he said.

The fact that hospitals cut down on unneeded procedures early in the pandemic demonstrates they are capable of assessing what care is and isn’t necessary, Saini said. “We have to understand how and why decisions were made during that period, and then begin to understand how to get rid of low-value care,” he said.

In 2020, hospitals placed 45,176 coronary stents — the most overused service of those considered unnecessary — and 30,094 back surgeries that met the criteria for overuse. Around one in five coronary stents performed annually are considered unnecessary, according to the study.

These types of procedures are not valuable enough to justify the risks, especially for older patients at jeopardy of contracting severe cases of COVID-19 in hospitals, Signature said.

Nationwide, the average rate of coronary stent overuse is 21%. Leading facilities such as the Cleveland Clinic, Houston Methodist Hospital and Mt. Sinai Hospital in New York, had unnecessary stenting rates at least double the national average.

Blood clots that can lead to strokes, heart attacks, heart artery injuries, catheter site infections and allergic reactions or kidney damage from the dye and contrast used are all potential risks of stenting, in addition to other hospital-acquired conditions.

Hospitals in Oregon, Maine and Vermont had the lowest rates of low-value procedures from 2018 to 2020, the study found. Florida, Mississippi and Alabama landed on the opposite end of the spectrum.

Highland Hospital in Rochester, New York, had the lowest rate of overused procedures and Richardson Medical Center in Rayville, Louisiana, had the highest.

Health systems that own more physician groups typically are associated with higher rates of unnecessary care, according to a Johns Hopkins University study published in JAMA this year. Facilities that perform fewer unnecessary services are more likely to be academic medical centers, employ larger numbers of primary care doctors or use integrated delivery models, that study found.


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