Study finds Medicare paid nearly $2 billion for unnecessary back surgeries

Editor's Note

More than 200,000 older Americans underwent back surgeries they likely did need, costing Medicare and Medicare Advantage a combined $1.9 billion, Axios October 9 reports. The findings, based on an analysis by the Lown Institute, raise new concerns about overuse of high-cost procedures with limited benefit, as federal administrators ramp up efforts to curb low-value care through clinical review and artificial intelligence tools.

The study reviewed Medicare fee-for-service data from 2021 to 2023 and Medicare Advantage claims from 2020 to 2022, identifying widespread variation in how hospitals use spinal procedures. Roughly 13% of spinal fusions and laminectomies met criteria for overuse, meaning they were performed on patients without conditions such as trauma, scoliosis, or herniated discs. Similarly, about 10% of vertebroplasty procedures—where bone cement is injected into cracked vertebrae—were deemed unnecessary, particularly when done for fractures caused by osteoporosis.

As detailed in the article, overuse rates varied widely even within the same state. At WellSpan York Hospital in Pennsylvania, 7.4% of spinal fusions were considered unnecessary, compared with 57.2% at Mount Nittany Medical Center. California, Florida, Texas, and Pennsylvania recorded at least 5,000 unnecessary spinal fusions each, while Texas, Florida, and Ohio led the nation in vertebroplasty overuse, with 6,000 or more questionable cases per state.

The Lown Institute’s findings align with previous research suggesting many back surgeries offer little advantage over conservative treatments for age-related pain. Procedures like vertebroplasty remain common despite mixed evidence on their effectiveness.

An American Hospital Association spokesperson disputed the analysis, arguing it relied too heavily on claims data and failed to account for physicians’ clinical judgment or patients’ full medical histories. The association said the study’s conclusions about what constitutes a “necessary” procedure were overly broad and did not reflect the complexity of individual cases.