Texas is home to three of the ten U.S. hospitals that overuse stents the most, according to new research from The Lown Institute. The costly procedure is unnecessarily performed every seven minutes, and UT Southwestern’s Clements University Hospital is among the facilities that overuse stents the most.
The Lown Institute is an independent think tank that examined the overuse of percutaneous coronary interventions (coronary stent or balloon angioplasty) at 1,733 hospitals and outpatient facilities that perform the procedure, finding that 229,000 procedures qualified as overuse. When used appropriately, the procedure can save the life of someone experiencing a heart attack, but its overuse costs Medicaid and U.S. taxpayers $800 million per year, Lown found. The think tank estimates that more than 20 percent of all stents placed in Medicare patients between 2019 and 2021 were unnecessary at a cost of $2.44 billion.
While no one doubts the importance of the procedure during or right after a heart attack, many of the unnecessary stents are being used for those with stable heart conditions, which research shows are better treated with medication therapy. Not only is this costly, but heart surgery is more dangerous for patients than other cheaper, safer, and more effective treatments. The stent procedure can result in a tear or perforation of the coronary artery, infection or bleeding where the catheter is inserted, blood clots that can result in stroke or heart attack, and the dye or contrast can cause kidney damage.
“What drives this is that we have a system in which practice doesn’t keep up with evidence,” says Dr. Vikas Saini, a cardiologist and president of The Lown Institute. “After 35 years of trials, the paradigm of the illness is totally wrong. With each successful year and trial showing it doesn’t work, there is less and less justification for continuing the practice.”
Lown found that Northwest Texas Hospital in Amarillo overused stents more than any hospital in the country. Of the 1,394 stents the hospital placed between 2019 and 2021, Lown found that 53 percent met the overuse criteria (see table below). Clements University Hospital was the sixth on the list of top ten hospitals with the highest rate of stent overuse, with 45 percent of the hospital’s 622 stents meeting the criteria for overuse between 2019 and 2021. The Medical Center of Southeast Texas in Port Arthur was also on the list at No. 9. No other state had more than one hospital on the list.
| Name | Stents meeting overuse criteria | Total stents | Overuse rate |
| Northwest Texas Hospital (Texas) | 733 | 1394 | 52.58% |
| Riverview Regional Medical Center (Ala.) | 401 | 802 | 50.00% |
| Kansas Medical Center LLC (Kan.) | 415 | 849 | 48.88% |
| UW Medical Center - Montlake (Wash.) | 713 | 1544 | 46.18% |
| Riverside Medical Center (Ill.) | 299 | 653 | 45.79% |
| UT Southwestern - William P .Clements Jr. University Hospital (Texas) | 277 | 622 | 44.53% |
| Terrebonne General Health System (La.) | 321 | 725 | 44.28% |
| Keck Hospital of USC (Calif.) | 260 | 603 | 43.12% |
| The Medical Center of Southeast Texas (Texas) | 261 | 608 | 42.93% |
| MUSC Health Columbia Medical Center Downtown (S.C.) | 484 | 1156 | 41.87% |
Lown analyzed Medicare Advantage and fee-for-service claims for 2019 and 2020 and only fee-for-service claims for 2021, as Medicare Advantage claims were not available for that year. A stent was deemed unnecessary in patients with ischemic heart disease at least six months before the procedure, excluding patients with unstable angina or heart attack in the last two weeks or patients who visited the emergency department in the two weeks before the operation. For Medicare patients, the procedure costs $10,615, of which Medicare pays for $9,015.
The data showed significantly different rates at hospitals in the same state or region, meaning that stent overuse is likely influenced by the facility’s culture rather than best practice or policy. The hospital with the lowest overuse rate in the state was Texas Health Fort Worth, which is of the same joint venture network of hospitals with Clements via Southwestern Health Resources. South Carolina had hospitals with a 42 percent overuse rate and a 6 percent overuse rate, two of the highest and lowest rates in the country, respectively.
Saini says that the pay incentives in the healthcare system, which encourage overuse in a fee-for-service model, are the true driver. Alternative payment models like value-based care can change some of the incentives around expensive procedures that aren’t necessary, but it is hard to dial back an operation that is used so widely. “The practice continues because it made money for cardiologists and made money for the hospitals,” Saini says. “The horse is out of the barn door.”
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