Examining Unnecessary Medicare Patient Surgeries During First Year of Pandemic

by MCOL Staff, May 20, 2022

The nation’s hospitals performed more than 100,000 unnecessary and potentially harmful procedures on older patients between March and December 2020, according to a new analysis by the Lown Institute, a healthcare think tank. Coronary stents and back surgeries were among the most-performed unnecessary procedures over this period.

The analysis of Medicare claims data shows that thousands of vulnerable patients were admitted to U.S. hospitals during the height of the pandemic, before COVID-19 vaccines were approved, for procedures that offer little to no clinical benefit or were more likely to harm patients than help them. The analysis of eight unnecessary and potentially harmful procedures is the first to measure rates of overuse at U.S. hospitals during the COVID-19 pandemic.

“You couldn’t go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures,” said Vikas Saini, MD, president of the Lown Institute. “The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”

Volume of eight low-value procedures in U.S. hospitals per Medicare claims

• Stents for stable coronary disease: 45,176 (42%)
• Vertebroplasty for osteoporosis: 16,553 (16%)
• Hysterectomy for benign disease: 14,455 (14%)
• Spinal fusion for back pain: 13,541 (13%)
• Inferior vena cava filter: 9,595 (9%)
• Carotid endarterectomy: 3,667 (3%)
• Renal stent: 1,891 (2%)
• Knee arthroscopy: 1,596 (1%)
• Total unnecessary procedures identified: 106,474

Coronary stents were the most overused by volume of all the procedures. Across the country, approximately one in five met criteria for overuse, including at some of the nation’s most well-regarded hospitals. For example, among the U.S. News top 20 hospitals, all had rates of coronary stent overuse above the national average, and four had rates at least double that: Cleveland Clinic (44%), Houston Methodist Hospital (44%), Mt. Sinai (42%), and Barnes Jewish Hospital (42%).

For this analysis, the Lown Institute used data from the 100% Medicare claims database from January – December 2020 to evaluate volume of overuse for eight common low-value procedures. Procedures and overuse criteria were based on Lown’s previously published research into measurement of low-value care at hospitals

Spring is Here and Medicare Advantage is in Full Bloom

MCOL Staff, April 7, 2022

Mark Farrah Associates has released their assessment of Medicare Advantage  and Prescription Drug Plan  performance, market share and market penetration as of March, 2022. They report that total MA membership exceeded 29.4 million and Medicare stand-alone PDPs covered over 23.4 million members. Year-over-year MA plan enrollment grew by 8.5%, and PDPs experienced a membership decrease of -3.4%.

MFA tells us that:

• Texas experienced the most sizeable year-over-year increase of over 172,000 MA members.
• Stand-alone PDPs continued to see a significant decrease of approximately 824,000 enrollees between March 1, 2021 and March 1, 2022.
• CVS, Centene, UnitedHealth, Humana and Cigna were the top five companies that dominate 88.5% of the PDP market.

MFA reports that In the MA world, UnitedHealth in March 2022 holds the top position with 27.1% marketshare, followed by Humana with 17.4%, CVS Health with 10.7%, Anthem with 6.5% and Kaiser with 6.1%.

Also, here’s the March 2022 MA/PDP Snapshot recently released by MCOL in HealthExecSnapshot: