Study shows levels of unnecessary procedures persisted during pandemic

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

According to an analysis of Medicare claims data from 2018 to 2020, between March and December 2020, hospitals performed more than 100,000 procedures for older patients that were deemed overburdened.

These services, which are considered to be of little clinical benefit to patients and present additional risks, include hysterectomy for benign disease, coronary stents for stable heart disease, and spinal fusion for low back pain.

According to Dr. Vikas Saini, president of the Lown Institute, volumes of both necessary and unnecessary procedures have declined due to shutdowns due to the pandemic in April and May 2020. As COVID-19-related restrictions eased and cases of coronavirus infection rose, the volume of low-value medical care increased, almost reaching pre-pandemic levels, he said.

The fact that hospitals reduced the number of unnecessary procedures at the beginning of the pandemic demonstrates that they are able to assess what care is needed and what is not, Saini said. “We need to understand how and why decisions were made during this period, and then begin to understand how to get rid of low-value care,” he said.

In 2020, 45,176 coronary stents were placed in hospitals—the most overused service considered unnecessary—and there were 30,094 spinal surgeries that met the overusage criteria. According to the study, approximately one in five coronary stents placed annually is considered unnecessary.

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

The national average for coronary stent overuse is 21%. At leading institutions such as the Cleveland Clinic, Houston Methodist Hospital, and Mount Sinai Hospital in New York, the rate of unnecessary stenting is at least twice the national average.

Blood clots, which can lead to strokes, heart attacks, damage to the heart arteries, infection at the site of the catheter, and allergic reactions or damage to the kidneys due to dye and contrast, are potential risks of stenting, in addition to other nosocomial conditions.

The study found that hospitals in Oregon, Maine, and Vermont had the lowest rates of low-cost procedures from 2018 to 2020. Florida, Mississippi and Alabama were on the opposite end of the spectrum.

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

According to a Johns Hopkins University study published in JAMA this year, health care systems that have more groups of doctors tend to be associated with higher levels of unnecessary care. This study found that facilities that provide fewer unnecessary services are more likely to be academic health centers, have more primary care physicians, or use integrated care models.