Analysis: Overuse of back surgeries costs Medicare $2 billion, risks patient safety

Editor's Note

More than 200,000 unnecessary back surgeries were performed on older adults from 2019 to 2021, costing Medicare approximately $2 billion and exposing patients to avoidable risks, according to a November 14 analysis from the Lown Institute.

The evaluation focused on spinal fusion, laminectomy, and vertebroplasty procedures, which are reportedly often shown to provide little benefit for certain patient groups. The analysis used Medicare claims data from 2019-2022 to identify overuse.

According to the report, spinal fusion and/or laminectomy was defined as overuse for patients with low-back pain if they did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain, or scoliosis. Vertebroplasty was defined as overuse for patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma, or hemangioma. Criteria excluded procedures with valid indications like neural claudication or structural abnormalities. Cost estimates combined outpatient procedure pricing and inpatient Diagnosis-Related Group (DRG) costs.

Rankings varied significantly from organization to organization. For example, Mount Nittany Medical Center (Pennsylvania) led the nation in overuse, with 62.8% of its spinal fusion/laminectomy procedures meeting overuse criteria. A single physician accounted for 92% of these cases. Conversely, hospitals like Avala Hospital (Louisiana) and Northwest Specialty Hospital (Idaho) reported overuse rates below 2%. Variation was particularly significant among institutions performing at least 500 procedures. For example, UC San Diego Medical Center reported only 1.9% overuse, while the Hospital of the University of Pennsylvania had a 32.6% overuse rate.

The full analysis offers more detail on the findings and specific hospital performance data.