Catalyst for Payment Reform

Unnecessary surgery happens more often (& costs more) than you think

Unnecessary surgery happens more often (& costs more) than you think

Overuse, misuse, and underuse of care are all types of inappropriate care that can result in negative patient outcomes and increased health care costs.  In fact, it is estimated that over $210 billion is wasted on these unnecessary services and procedures.

Back pain and spinal surgery is a prime example. Low back pain is prevalent across the country—more than 80 percent of Americans will experience it over their lifespan. Oftentimes, patients receive CT scans, MRIs, or X-rays to determine the cause of their back pain, but many patients don’t need this level of imaging and may be needlessly exposed to radiation by receiving it. Moreover, inappropriate imaging often leads to inappropriate procedures, such as surgery, when a less invasive treatment could lead to better outcomes.

A 2011 paper published in Surgical Neurology International found that just over 17 percent of all patients who were advised to go in for spinal surgery did not really need the procedure.  CPR’s 2018 employer case study documents how Walmart Inc. found that 50 percent of spinal surgeries were unnecessary after implementing a centers of excellence program for spine surgery.

The overprescribing of opioids to treat low back pain also contributes to the worsening of the opioid epidemic. Smart Care California is working with providers and health plans across the Golden State to implement evidence-based guidelines and identify actions they can take to improve care for low back pain.

On top of that, a recent survey found that almost 65 percent of surveyed physicians believe that up to 30 percent of medical care is unnecessary.  Even providers see a significant opportunity to reduce waste in health care.

So, what can employers do about it?

On September 11, 2018, CPR hosted a Virtual Summit: Why Inappropriate Care Matters to Employers and What They Can Do About It.  The event featured policy experts along with leading purchasers to cover the scope of inappropriate care and how the current system can perpetuate it, what levers are available to employers to address inappropriate care, and the strategies and programs employers are implementing to help the members of their population.

Watch the webinar recording!

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