20 May The overuse of medical procedures in American hospitals: Lown Institute Hospital Index data
Doctors are colloquially known to operate by the mantra “do no harm” and when American’s seek medical care, they expect their provider to be making decisions in their best interest. Doing no harm to patients includes not putting them through unnecessary treatments. However, a May 2021 press release from the Lown Institute has drawn attention to the pervasive problem of the overuse of diagnostic testing and medical procedures in American hospitals.
The data came from Medicare claims from 2018 to 2019 and includes 3,282 hospitals ranked on the overuse of 13 “low-value” procedures. To accurately rank overuse in hospitals, the procedures were given definitions based on the literature as to what would be considered overuse, and then hospitals that performed at least four tests and eight procedures were ranked based on the rate and volume of overuse. Perceived limitations include that the source of this data is Medicare claims; it is comprised of older Americans and not currently generalizable to the national population. Additionally, the analysis represents procedures done at least two years ago, so there may have been a change since then.
Patterns in the data showed that the hospitals that were most likely to be overusing services were in the South, while the North East and the Pacific North West regions were least likely to be overusing procedures. Additionally, private hospitals were consistently more likely to be overusing procedures than public hospitals. Large teaching hospitals and non-teaching hospitals outperformed small-teaching hospitals, and nonprofit and rural hospitals outperformed for-profit and urban hospitals.
The rate and location of overuse differed by procedure, for example, 64% of hysterectomies met the criteria for overuse nationwide. There were higher clusters of unnecessary hysterectomies in the South; historically Black and Native women are at an increased likelihood of receiving hysterectomies for benign disease compared to white women in this region. This points to implicit bias taking place on the part of the medical providers and resulting in differences in the treatment of patients.
It costs the healthcare system billions of dollars each year to be overusing diagnostic testing and medical procedure and puts patients under unwarranted stress. The resources used for these unnecessary procedures would be much better served where there is a confirmed need. Urgently, some medical procedures can cause undue harm through side effects of treatment, causing easily avoidable problems.
Now that there is confirmation of this misuse of services, we need to get to work improving the quality of care by understanding what is causing overuse. A shift in policy and hospital culture could both be impactful in creating a change. Additionally, hospitals need to be held responsible for data transparency. Patients deserve to trust their providers and expect that procedures they undergo are medically necessary. This new ranking system by the Lown Institute is a step in the right direction of accountability and change.
To read more about the 2021 hospital overuse rankings, follow this link: https://lownhospitalsindex.org/2021-winning-hospitals-avoiding-overuse/