Which health systems are doing the most to reduce overuse?

Overuse— also known as low-value care or unnecessary care— is widespread in American health care, and poses a significant threat to patient safety and financial sustainability. However, not all hospitals or health systems give patients unnecessary tests and services at equal rates. Identifying the providers who effectively avoid overuse, as well as those who are overuse outliers, can show which policies are working well to reduce low-value care, and point to where more targeted interventions are necessary.

The Lown Hospitals Index was the first to evaluate more than 3,000 hospitals and 300 hospital systems on how well they avoid 12 common low-value services for Medicare patients. Researchers have since conducted analyses of low-value care throughout the system, including outpatient clinics, skilled nursing facilities, and home health agencies.

In a new study in JAMA Health Forum, Dr. Jodi Segal at the Johns Hopkins School of Public Health and colleagues evaluate overuse at 676 health systems using an Overuse Index consisting of 17 low-value services. These services, which include MRIs for patients with mild brain injuries, spinal fusions for back pain and pap smears for women over age 65, are indicators of systemic overuse that have been validated in both Medicare and commercially insured populations.

Dr. Segal and colleagues found that health systems with higher overall rates of overuse had more beds and fewer primary care physicians; they were also more likely to be for-profit systems and less likely to be associated with a major teaching hospital.

More physician groups within a system was also associated with overuse, which means that further hospital consolidation going unchecked could lead to more low-value care.

“As hospitals restructure themselves into larger and larger systems, senior leadership of hospitals will have to own this problem, said Dr. Vikas Saini, in Modern Healthcare.

Although the JHU study and the Lown Index measure overuse of different health services, some of the patterns in these two analyses match up. According to the Lown Index, none of the top hospital systems for avoiding overuse are for-profit systems, although some on the bottom are (see tables below). The Lown Index also found that major teaching hospitals had better rankings on avoiding overuse compared to nonteaching hospitals.

Best health systems for avoiding overuse, 2021

Name	State	Number of hospitals in system	LIHI overuse rank	LIHI overuse grade
UMass Memorial Health Care, Inc.	MA	2-3	1	A
Samaritan Health Services	OR	4-9	2	A
St. Luke’s Health System	ID	4-9	3	A
MaineHealth	ME, NH	4-9	4	A
Northern Light Health	ME	4-9	5	A
Virginia Mason Health System	WA	2-3	6	A
HealthPartners	WI, MN	4-9	7	A
Central Maine Healthcare	ME	2-3	8	A
UCHealth	CO	4-9	9	A
Beth Israel Lahey Health	MA	4-9	10	A
Vanderbilt Health	TN	2-3	11	A
North Memorial Health Care	MN	2-3	12	A
Centra Health, Inc.	VA	2-3	13	A
Carle Foundation	IL	2-3	14	A
Legacy Health	WA, OR	4-9	15	A
UC Health	OH	2-3	16	A
Nuvance Health	CT	2-3	17	A
Lifespan Corporation	RI	2-3	18	A
Essentia Health	WI, MN, ND, ID	10-19	19	A
Mayo Clinic	FL, WI, MN, IA, AZ	20-39	20	A

Worst health systems for avoiding overuse, 2021

Name	State	Number of hospitals in system	Ownership type	LIHI overuse rank	LIHI overuse grade
Central Florida Health	FL	2-3	Nonprofit	311	D
Methodist Health System	TX	2-3	Nonprofit	310	D
Houston Healthcare System	GA	2-3	Nonprofit	309	D
Baptist Health	AL	2-3	Nonprofit	308	D
Houston Methodist	TX	4-9	Nonprofit	307	D
Curae Health	AL, MS	2-3	Nonprofit	306	D
Baptist Health South Florida	FL	4-9	Nonprofit	305	D
Rush Health Systems	MS	2-3	Nonprofit	304	D
McLeod Health	SC	4-9	Nonprofit	303	D
Regional Medical Center	AL	2-3	Nonprofit	302	D
Memorial Healthcare System	FL	2-3	Nonprofit	301	D
Mary Washington Healthcare	VA	2-3	Nonprofit	300	D
Union General Hospital, Inc.	GA	2-3	Nonprofit	299	D
Greater Hudson Valley Health System	NY	2-3	Nonprofit	298	D
Physicians for Healthy Hospitals	CA	2-3	For-profit	297	D
LifeBridge Health	MD	2-3	Nonprofit	296	D
Hackensack Meridian Health	NJ	4-9	Nonprofit	295	D
Allegiance Health Management	AR, LA	4-9	For-profit	294	D
CarePoint Health	NJ	2-3	For-profit	293	D
Broward Health	FL	2-3	Nonprofit	292	D

The JHU researchers found that St. Dominic’s health system in Jackson, MS, had the worst score of any system on their overuse index. On the Lown Index, St. Dominic-Jackson Memorial Hospital, which is part of that system, also scored poorly on avoiding overuse.

In Modern Healthcare, a St. Dominic’s official said that they are “committed to exploring this study and taking any necessary actions to ensure our patients, community and region receive the most exceptional, safe and effective care.” If research like the JHU study and the Lown Index can prompt system leaders to reduce unnecessary care, that’s a big step in the right direction.