About 11% of the nation's health systems are big-time over-utilizers of low-value services, according to a Johns Hopkins University study published in JAMA on Friday.
Health systems that employ fewer primary care physicians, have higher bed counts or are investor-owned are associated with more unneeded care, researchers at Johns Hopkins' medical and public health schools found. Unnecessary procedures, tests and screenings are linked to lower quality of care and worse patient and worker safety, and drive up healthcare costs.
Among the top over-users were St. Dominic Health Services of Jackson, Mississippi, Irving, Texas-based USMD Health System, Community Medical Centers of Clovis, California, and Providence, Rhode Island-based Care New England Health System, according to the study.
USMD Health System is the only for-profit health system topping the list of over-users, but others scored above average, such as Nashville, Tennessee-based HCA Healthcare, Tenet Healthcare of Dallas, King of Prussia, Pennsylvania-based Universal Health Services and Community Health Systems of Franklin, Tennessee.
The study analyzes Medicare claims data from 2016-2018 at 3,745 hospitals for 17 services previously identified as unnecessary, such as MRIs for patients with mild traumatic brain injuries, spinal fusions for back pain and pap smears for women over age 65. A health system's usage of these types of services relative to its peers serves as a proxy for whether its hospitals provide unneeded care, according to the study.
"This type of tool has the potential to provide guidance for health systems on which practices they might de-implement," said Rinad Beidas, the director of the Penn Implementation Science Center at the University of Pennsylvania, who was not involved in the research. "Given the immense strain on our [healthcare] system and clinicians over the past two years, identifying practices for de-implementation are even more important to reduce burden on our workforce."