According to research from the Lown Institute Hospitals Index, Texas is the fourth-worst U.S. state for avoiding overuse in hospitals. Dallas ranked 256 of 306 regions, and Fort Worth ranked 249. The index evaluates how well hospitals avoid tests and procedures that don’t benefit patients.
According to Lown’s research, every 80 seconds, a hospital in the U.S. delivers a low-value test or procedure to an older adult; Medicare and tax dollars often pick up the tab. Nearly two-thirds of all hysterectomies and almost a quarter of coronary stent procedures met the criteria. The survey looked at Medicare data between 2016 and 2018 for 3,100 hospitals around the country and identified 12 low-value services that hospitals provided, things like arthroscopic knee surgery, and unnecessary hysterectomy, and spinal fusion. These are services that are almost always unnecessary and often harmful, according to the report. Not only are these procedures a waste of money, but they also add risk for patients and don’t improve clinical outcomes.
The overuse is rarely due to bad actors, though some physicians try to rack up fees by ordering more tests or procedures. At times, our technology is our own worst enemy, says Dr. Vikas Saini, president of the Lown Institute. “The problem with many of the diagnostic tests is sometimes our technology is now so good that we detect things that seem like they’re problems. Given the resolution of the technology, we’re detecting things that were never detected before, and it is so small that it really wouldn’t end up bothering you at all. The risk of diagnostic test could mean that you’ll get a cascade of more tests, and eventually you may get a procedure you might not have needed.”
The hospitals that avoided low-value services were not facilities that one might find in the more popular hospital rankings. In fact, only Cleveland Clinic was ranked in the top 100 for overuse found in the U.S. News Best Hospitals list. This is the second year that the Lown Institute has done the ranking. The South was home to 41 of 50 hospitals that overused low-value procedures the most, with five of the bottom 10 hospitals in Florida. The Pacific Northwest and New England were stronger in the rankings.
None of the top 50 hospitals for avoiding overuse were in Texas, but 10 Texas facilities were on the bottom 50 in the country to prevent overuse. Methodist Richardson Medical Center was ranked in the bottom 50, as were UT Health East Quitman Medical Center and Palestine Regional Medical Center. Overall, Texas was ranked 48 of 51 (Washington, D.C. was included) in the country for hospital overuse. Baylor Scott & White Pavilion in Temple was ranked as the best hospital for avoiding overuse in Texas.
North Texas has long been known to be one of the more expensive places for healthcare in the country. Part of that may be the high number of uninsured residents (Texas has the highest rate and number of uninsured residents in the country), which means that hospitals are picking up the tab for charity care for uninsured patients and getting reimbursed by government payers. But hospitals say that this system doesn’t cover their costs, which have to be made up somewhere. In general, Saini said that the group hasn’t done enough analysis to really suss out why certain states are doing worse than others, but he did sat that smaller regional and non-academic teaching hospitals tend to include more overuse. The size of Texas necessitates more regional medical centers in small towns throughout the state, which could be a factor for why it scores so low on the overuse rating.
The Lown Institute zoomed in on 12 low-value services that hospitals provided, like arthroscopic knee surgery, a hysterectomy, and spinal fusion. It wasn’t all bad news for DFW, as UT Southwestern’s Clements University Hospital was the top-ranked hospital for avoiding an EEG for a headache. While there are plenty of tests and procedures that may be necessary but can be overused, the 12 procedures that the study highlighted are a different story. “For those 12 items, there’s not a lot of gray here. This is pretty black and white. These are things that you generally shouldn’t need or shouldn’t be having.”
So what can patients do to make sure they aren’t receiving unnecessary care that may put them in danger? Saini says that seeking a second opinion can help, though that isn’t always possible in small towns with one hospital or due to time restraints. “There are some questions that patients can ask,” Saini says. “Things like, ‘What are you going to do with the information? How will what you get changed what you would do?’ If there’s not a clear answer, you don’t need to do it.”
While patients can have an impact, the fee-for-service payment model and lack of accountability are even more significant drivers of the problem, adding incentives for unnecessary services. “The biggest responsibility lies with the healthcare system and doctors,” Saini says. “There’s an inherent bias that it’s good to know rather than not know, but that’s not always true. Sometimes it’s not useful, and it could send you barking up the wrong tree.”
Read more about hospital overuse in the Journal of the American Medical Association here.