Unnecessary spine cases cost Medicare $2B over 3 years: Lown Institute

Spine

Between 2019 and 2021, more than 200,000 unnecessary spine surgeries cost Medicare an estimated $2 billion, according to an analysis from the Lown Institute. 

Seven things to know: 

1. The Lown Institute measured hospital overuse with Medicare fee-for-service and Medicare Advantage claims data for the most recent three years of data available, according to a Nov. 14 news release. 

2. On average, 14% of spinal fusions and/or laminectomies were considered "overuse." An average 11% of patient visits for osteoporotic fractures led to an unnecessary vertebroplasty.

3. "Overuse" was defined for spinal fusions and/or laminectomies if patients did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Vertebroplasty "overuse" was defined in patients who had fractures caused by osteoporosis, with some exclusions. 

4. States with the highest overuse of spinal fusions included New Hampshire, Iowa, Massachusetts, and Pennsylvania. Arkansas, Kansas, Oklahoma, and Nevada were among states with the highest vertebroplasty overuse rates.

5. A total of 3,454 physicians performed "a measurable number" of low-value spine surgeries, the Lown Institute found. Over three years they received a total $64 million from device and drug companies.

6. Mount Nittany Medical Center in State College, Pa., has the highest rate of unnecessary spinal fusion/laminectomy in the nation at 62.8%. One physician was responsible for most of those cases. Mount Nittany Health System didn't immediately respond to a request for comment from Becker's.

7. Avala Hospital in Covington, La., had the lowest rate of unnecessary spinal fusion and/or laminectomy.

Read the full report here.

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