Hospitals with a greater number of beds and fewer primary care physicians are more likely to provide unnecessary medical tests or treatments, according to a study led by researchers at the Johns Hopkins School of Medicine and Bloomberg School of Public Health.

The study published in JAMA Health Forum on January 14, 2022 also found investor-owned hospitals were associated with higher rates of low-value or no-value care. Teaching hospitals and those with the largest percentage of care that was uncompensated by patients or insurers were less likely to perform unneeded procedures.

The researchers analyzed Medicare claims from 2016 to 2018 from 3,745 hospitals to look for 17 examples of unnecessary care. These include mammograms for women over 85, colonoscopies for people over 80, hysterectomies for benign conditions, and spinal fusions for back pain.  Such procedures are time-consuming, costly, and negatively affect a persons quality of life. A 2019 study found that unnecessary care, also known as medical overuse, leads to $75 to $100 billion dollars in wasted spending annually. 

“Overuse of health care, or the provision of low-value or no-value care, is consistently identified as contributing to high costs in the U.S. health care system,” wrote the authors, who include Jodi B. Segal, a professor at the School of Medicine; and Aditi P. Sen, a professor at Bloomberg School of Public Health, who are both HBHI core faculty. “This wasteful care is physically, psychologically and financially harmful to patients.”

The researchers revised a tool known as the Overuse Index to evaluate the hospitals, which are part of 676 healthcare systems. The index can be used to identify and change factors leading to unnecessary medical care, can be adapted to analyze medical overuse at the state or regional level, and can highlight ways to reduce or eliminate unnecessary care.