By Aaron Toleos, May 4, 2021.
U.S. hospital ranking identifies best and worst hospitals at avoiding overuse of hysterectomy, coronary stents, back surgery, and more
BROOKLINE, Mass. — Every 80 seconds, a hospital in the U.S. delivers a low-value test or procedure to an older adult, putting hundreds of thousands at risk of harm, according to a new analysis from the Lown Institute, a health care think tank. The Institute today released a ranking of over 3,100 U.S. hospitals that examines success at avoiding the use of tests and procedures that offer little to no clinical benefit.
The Institute finds that more than 1 million tests and procedures performed in hospitals on Medicare patients from 2016-2018 met established criteria for overuse. Among the 12 low-value services measured, hysterectomy for benign disease, the placement of coronary stents for stable heart disease, and diagnostic tests like head imaging for fainting were particularly widespread, with more than 90 percent of hospitals overusing these tests or procedures.
“Overuse in American hospitals is a pervasive problem that needs to be addressed,” said Vikas Saini, MD, president of the Lown Institute. “Hospitals want to do better and these objective measures of performance can help them move forward.”
The nation’s top hospitals for avoiding overuse are not the most well-known institutions in the country, but regional health care providers. Notably, providers in the southern United States are absent from the list of top hospitals. The best performers for avoiding unnecessary tests and procedures are:
- Scott County Hospital (Scott City, KS)
- Beth Israel Deaconess Medical Center (Boston, MA)
- West River Regional Medical Center (Hettinger, ND)
- Highland Hospital (Rochester, NY)
- Mayo Clinic Health System – Lake City (Lake City, MN)
- Maine Medical Center (Portland, ME)
- Sidney Regional Medical Center (Sidney, NE)
- Mary Hitchcock Memorial Hospital (Lebanon, NH)
- Healdsburg District Hospital (Healdsburg, CA)
- Contra Costa Regional Medical Center (Martinez, CA)
New England & Pacific Northwest are best, south worst at avoiding overuse
Out of the 50 top performing hospitals, nine are in New England and 10 in the Pacific Northwest, making those regions stand out at the top of the list. The South was home to 41 of the 50 lowest-performing hospitals, with five of the bottom 10 located in Florida.
Elite hospitals hard to find at the top
The Cleveland Clinic (58th) was the only hospital from the current U.S. News honor roll to break into the Lown top 100 for avoiding overuse. Most others placed in the top third with Houston Methodist being an outlier at 2756th. Looking specifically at the overuse of coronary stents, Mount Sinai Hospital in New York ranked particularly poorly, having performed 1,230 procedures that were likely unnecessary in the three years examined.
Other notable findings:
- Nationwide, 64 percent of hysterectomies analyzed met established criteria for overuse. In North Dakota and Wyoming, the rate of hysterectomy overuse was 90 percent and 94 percent, respectively.
- Nearly one in four coronary stent procedures met established criteria for overuse nationwide. As many as 200,000 patients may have had stents placed unnecessarily over the years studied.
- Vertebroplasty, a procedure to inject cement into the spine, which has been found to be ineffective for osteoporosis-related fractures in numerous trials, is still overused by many hospitals. In Florida alone, more than 3,600 vertebroplasties were performed in the years studied.
Comprehensive ranking information including an explanation of methods is available at LownHospitalsIndex.org/overuse.