Healthcare News of Note: U.S. hospitals performed 106,474 unnecessary procedures on older adults during the ‘dangerous’ first year of COVID-19

• More than 100,000 “low-value procedures” were performed  on older adults by the nation’s hospitals between March and December 2020, according to a new analysis.
• Telehealth visits for outpatient mental health and substance use services went from virtually zero in 2019 to a peak of 40% in mid-2020.
• Women and people of color with chest pain waited longer in the emergency department to be seen by physicians, independent of clinical features, compared with men and white adults, according to a new report.

Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.   

1. Lown Institute says U.S. hospitals performed 106,474 unnecessary procedures on older adults during the ‘dangerous’ first year of COVID-19

A total of 106,474 “low-value procedures” were performed on older patients by the nation’s hospitals during the “dangerous first year” of the pandemic — March through December 2020 — according to a May 17 Lown Institute news release.

In the release, Vikas Saini, MD, president of the Lown Institute, said, “You couldn’t go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures. The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”

“The Lown Institute is the first to measure rates of hospital overuse during the COVID-19 pandemic,” the analysis states. “Overuse, or low-value care, refers to medical services that offer little to no clinical benefit or are more likely to harm patients than help them.

“Eight low-value procedures were examined, including hysterectomy for benign disease, coronary stents for stable heart disease, and spinal fusion for low-back pain. The eight procedures were chosen based on validation in previous overuse studies.”

Key findings

Based on an examination of Medicare claims, the numbers of such procedures in U.S. hospitals were as follows:

• 45,176 — Stents for stable coronary disease
• 16,553 — Vertebroplasty for osteoporosis   
• 14,455 — Hysterectomy for benign disease
• 13,541 — Spinal fusion for back pain
• 9,595 — Inferior vena cava filter
• 3,667 — Carotid endarterectomy
• 1,891 — Renal stent
• 1,596 — Knee arthroscopy

State rankings:

The Lown Institute also ranked all states by average performance on avoiding overuse:

• Oregon, Maine, Vermont, Minnesota and South Dakota were listed as the top five states in avoiding overuse.
• Alabama, Mississippi, Florida, Kentucky and Texas were listed as the bottom five states in avoiding overuse.

2. Shortage of mental health providers in rural areas may have fueled demand for telehealth services during one pandemic period

A shortage of mental health providers in rural areas is likely the reason “a relatively high share of patients in rural areas (55%) relied on telehealth to receive outpatient mental health and substance use services compared to those in urban areas (35%)” in March-August 2021, according to a new analysis from KFF and Epic Research.

“Telehealth may provide a way to improve access to mental health and substance use disorder care, particularly for people living in areas with fewer providers,” wrote the report’s authors. “Though differences in comfort with technology, digital literacy and lack of internet at home may hinder access to telehealth for some.”

Other study highlights

Researchers also noted the following:

• Overall telehealth visits for outpatient mental health and substance use services went from virtually zero in 2019 to a peak of 40% in mid-2020 — and continued to account for 36% of such visits in the six months ending in August 2021.
• Telehealth use in March-August 2021 “was significant across major mental health and substance use disorder conditions,” from trauma-related use at 43% (listed as the highest use of telehealth) to stimulant-related issues at 16% (listed as the lowest use among telehealth services). Anxiety-related use of telehealth was 38% and depressive disorder use 35%.

3. Women and people of color with chest pain wait longer to be seen by a physician in the ED than men and white adults

Women and people of color with chest pain waited longer in the emergency department (ED) to be seen by physicians, independent of clinical features, compared with men and white adults, respectively, according to a report published May 4 in the Journal of the American Heart Association.

For this study, patients ages 18 to 55 presenting to the ED with chest pain between 2014 and 2018 were identified using the CDC’s National Hospital Ambulatory Medical Care Survey.

According to this analysis of a large, nationally representative database, not only did women younger than 55 wait an average of 11 minutes longer than men in the same age range to be seen by a physician, but they also were less likely to:

• Be triaged as emergent (19.1% versus 23.3%)
• Undergo electrocardiography testing (74.2% versus 78.8%)
• Be admitted to the hospital or to observation (12.4% versus 17.9%)

There were no differences between women and men for ordering of biomarkers, according to the report.

“Sex differences in wait time and hospital admission persisted after multivariable adjustment,” wrote the authors.

“Young adults of color experienced longer wait times despite similar triage status compared with White adults after multivariable adjustment,” they also wrote. “Differences by sex and race in the early evaluation and management of chest pain warrant further study to evaluate their association with clinical outcomes and to identify opportunities for improvement in clinical care.”

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