In the last three years, U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries, according to a Nov. 14 report by the Lown Institute Hospital Index.
The Lown Institute, which used Medicare fee-for-service and Medicare Advantage claims data from the last three years, limited hospitals with the highest and lowest overuse rates to facilities with high volumes — at least 500 spinal fusions or patient visits for osteoporotic fractures. Spinal fusion and laminectomy procedures were deemed overused for patients with low back pain, excluding those with radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Vertebroplasty was considered overused for patients with spinal fractures caused by osteoporosis, excluding those with bone cancer, myeloma or hemangioma.
These procedures cost Medicare about $2 billion over three years. On average, 14% of spinal fusions met the criteria for overuse, and 11% of patient visits for osteoporotic fractures resulted in unnecessary vertebroplasty.
New Hampshire, Iowa, Massachusetts and Pennsylvania had the highest overuse rates for spinal fusion, with rates higher than 18%. Arkansas, Kansas, Oklahoma and Nevada had the highest overuse rates of vertebroplasty, with rates over 16%.
A total of 3,454 physicians performed a measurable number of these low-value back surgeries and received $64 million from device and drug companies for consultations, speaking fees, meals and travel.
Here is how the top 16 U.S. News & World Report hospitals in 2024-25 stack up for back surgery overuse:
|
Hospital |
Overuse rate of spinal fusion/laminectomy |
Overuse rate of vertebroplasty |
|
Brigham and Women's Hospital (Boston) |
16.4% |
2.0% |
|
Cedars-Sinai Medical Center (Los Angeles) |
17.7% |
2.4% |
|
Cleveland Clinic Main Campus |
13.8% |
0.5% |
|
Duke University Hospital (Durham, N.C.) |
12.7% |
4.2% |
|
Hospital of the University of Pennsylvania (Philadelphia) |
32.6% |
1.5% |
|
Houston Methodist Hospital |
10.2% |
17.9% |
|
Massachusetts General Hospital (Boston) |
20.9% |
8.0% |
|
Mayo Clinic in Phoenix |
6.6% |
19.5% |
|
Mayo Clinic (Minn.) |
11.7% |
8.4% |
|
Mount Sinai Hospital (New York City) |
12.4% |
13.9% |
|
NewYork-Presbyterian Hospital (New York City) |
19.5% |
7.5% |
|
North Shore University Hospital (Manhasset, N.Y.) |
13.1% |
5.0% |
|
Northwestern Memorial Hospital (Chicago) |
10.0% |
1.2% |
|
Ronald Reagan UCLA Medical Center (Los Angeles) |
n/a |
1.1% |
|
Rush University Medical Center (Chicago) |
12.1% |
2.3% |
|
Stanford Hospital (Palo Alto, Calif.) |
21.3% |
4.0% |
|
The Johns Hopkins Hospital (Baltimore) |
13.8% |
5.8% |
|
Tisch Hospital (New York City) |
7.9% |
8.0% |
|
UC San Diego Medical Center |
1.9% |
2.2% |
|
UCSF Medical Center (San Francisco) |
17.8% |
1.7% |