Over three years unnecessary back surgeries have cost Medicare an estimated $1.9 billion, according to an analysis from the Lown Institute.
Six things to know:
1. The Lown Institute evaluated Medicare fee-for-service claims from 2021 to 2023 and Medicare Advantage claims data from 2020 to 2022, according to an Oct. 8 news release. Overuse in spinal fusion/laminectomy patients was deemed for patients with low-back pain who did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Overuse for vertebroplasty was defined in patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma or hemangioma.
2. Physicians performed more than 200,000 unnecessary back surgeries on older adults, the Lown Institute found.
3. California and Florida had the highest volume of unnecessary spinal fusions, and both states had more than 6,000 cases that met the criteria for overuse.
4. Texas and Florida had the highest volume of unnecessary vertebroplasties. Texas had 9,937 overuse cases, and Florida had 8,302 overuse cases.
5. “Like everyone in America, older people with back pain deserve safe, evidence-based care that doesn’t waste taxpayer dollars,” Vikas Saini, MD, president of the Lown Institute, said in the release. “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.”
6. The Lown Institute’s findings come around a time when CMS is targeting overuse of medical services. One of those initiatives is the Wasteful and Inappropriate Service Reduction Model which includes vertebroplasty and 16 other procedures.
