Unnecessary Back Surgeries Cost Medicare $1.9 Billion, Study Shows

More than 200,000 unnecessary back surgeries on older adults cost Medicare $1.9 billion from 2020 to 2023, according to a new analysis from the Lown Institute.

"Insurance companies know about the problem and they've known about the problem for decades," Vikas Saini, M.D., president of the Lown Institute, said in a video interview with Managed Healthcare Executive. "They’ve abandoned their post because they've been doing well as prices keep rising."

Lower back surgeries, specifically spinal fusions, laminectomies and vertebroplasties, are procedures done to address lower back pain. Researchers classified states and hospitals with the highest and lowest rates of spinal fusion and laminectomy overuse.

The average overuse rate of vertebroplasties for all U.S. hospitals is 10%, and the average overuse rate of spinal fusion for all U.S. hospitals is 13%, with most hospitals having overuse rates of at least 33%.

During a laminectomy, a surgeon decompresses the spine by removing the lamina, a part of the vertebral bone, to alleviate pressure on the spinal cord. The surgeon may then permanently fuse the vertebrae together to prevent motion and increase spine stability by doing a spinal fusion.

A vertebroplasty is done to stabilize and prevent movement in the event of a vertebral compression fracture, using a bone cement injected into the fracture.

These surgeries are typically recommended for patients with lower-back pain caused by traumatic injury, sciatica or spinal deformity but are still done on older patients with age-related back pain, despite the lack of evidence of benefit when compared to non-surgical alternatives such as physical therapy, epidural steroid injections, or heat and cold therapy.

Overuse isn’t just expensive; it’s dangerous, according to the study. Complications occur in up to 18% of spinal fusion/laminectomy patients and up to 10% of vertebroplasty patients. They include infection, blood clots, stroke, pneumonia, heart and lung problems and in extreme cases, death.

Lown Institute researchers analyzed Medicare fee-for-service data from 2021 to 2023 and Medicare Advantage claims data from 2020 to 2022 to identify unnecessary procedures done on older patients.

Low-value back surgery cost was calculated using Medicare’s procedure price lookup tool. Researchers used the most frequent CPT code for the procedure. Inpatient procedure cost was calculated using the average Medicare cost of the most frequent Diagnosis Related Group code for the procedure, using Medicare fee-for-service claims data.

Overuse for spinal fusions/laminectomies and vertebroplasty was calculated using two previously validated overuse measures.

By state, the highest number of unnecessary spinal fusions occurred in Pennsylvania, California and Florida, with at least 5,000 procedures done in each state. By hospital, the highest rates of overuse occurred at Mount Nittany Medical Center (57%), Concord Hospital (41%) and Lutheran Hospital of Indiana (39%).

Ohio, Texas and Florida had the highest amount of vertebroplasty overuse—at least 6,000 unnecessary procedures were done in each state. The three hospitals with the highest rates of overuse were Kettering Health Miamisburg (56%), Shannon Medical Center (55%) and St. Elizabeth Florence Hospital (50%).

Eleven hospitals had the opportunity to perform an unnecessary procedure, calculated by patient symptoms, but did not. For example, MetroHealth Medical Center in Ohio performed no unnecessary vertebroplasties, despite 1,616 patient visits “qualifying” for one.

Reducing the amount of low value procedures requires a multi-step approach, according to Saini.

"Aligning incentives, more campaigns with clinicians and patients, plus more research and evidence would be my formula for tackling it," Saini said. "My hope is that there's a concerted effort to get what I think we all want, which is better health care with less waste, so we can provide more coverage for more people without costs skyrocketing."