Three Texas hospitals among the top 10 with highest rates of stent overuse
Every seven minutes, a Medicare patient receives an unnecessary coronary stent at a U.S. hospital, a new report finds. The Lown Institute, an independent think tank, examined overuse of percutaneous coronary interventions (coronary stent or balloon angioplasty) at 1,733 general hospital inpatient and outpatient facilities, and found more than 229,000 procedures met criteria for overuse.
While coronary stents can be lifesaving for someone having a heart attack, years of research shows that stents for stable heart disease provide no benefit over optimal medication therapy. Across all hospitals, Lown estimates that more than one-in-five stents were placed unnecessarily in Medicare patients from 2019 to 2021, at a cost of $2.44 billion.
“When physicians continue a practice despite the evidence against it, it becomes more dangerous than useful.” said Dr. Vikas Saini, a cardiologist and president of the Lown Institute. “The overuse of stents is incredibly wasteful and puts hundreds of thousands of patients in harm’s way.”
Possible complications from the procedure include tear or perforation of the coronary artery, infection or bleeding at the catheter site, blood clots that can lead to stroke or heart attack, and kidney damage from the dye or contrast.
Rates of overuse varied widely across hospitals, including institutions in the same state. In South Carolina, for example, 42 percent of stent procedures at MUSC Health Columbia Medical Center Downtown (formerly Providence Health) met criteria for overuse, while at Grand Strand Medical Center the rate was only 6 percent.
Hospitals with highest rates of stent overuse, 2019-2021
Includes general hospitals with above-average volume of total stents, in order of highest proportion of stents meeting overuse criteria.
| Name | Stents meeting overuse criteria | Total stents | Overuse rate |
| Northwest Texas Hospital (Texas) | 733 | 1394 | 52.58% |
| Riverview Regional Medical Center (Ala.) | 401 | 802 | 50.00% |
| Kansas Medical Center LLC (Kan.) | 415 | 849 | 48.88% |
| UW Medical Center – Montlake (Wash.) | 713 | 1544 | 46.18% |
| Riverside Medical Center (Ill.) | 299 | 653 | 45.79% |
| UT Southwestern – William P. Clements Jr. University Hospital (Texas) | 277 | 622 | 44.53% |
| Terrebonne General Health System (La.) | 321 | 725 | 44.28% |
| Keck Hospital of USC (Calif.) | 260 | 603 | 43.12% |
| The Medical Center of Southeast Texas (Texas) | 261 | 608 | 42.93% |
| MUSC Health Columbia Medical Center Downtown (S.C.) | 484 | 1156 | 41.87% |
Hospitals with lowest rates of stent overuse, 2019-2021
Includes general hospitals with above-average volume of total stents, in order of lowest proportion of stents meeting overuse criteria.
| Name | Stents meeting overuse criteria | Total stents | Overuse rate |
| Magnolia Regional Health Center (Miss.) | 8 | 647 | 1.24% |
| Kaiser Permanente San Francisco Medical Center (Calif.) | 14 | 884 | 1.58% |
| Kaiser Permanente Santa Clara Medical Center (Calif.) | 42 | 1131 | 3.71% |
| HCA Florida Northwest Hospital (Fla.) | 26 | 668 | 3.89% |
| Strong Memorial Hospital (N.Y.) | 67 | 1238 | 5.41% |
| Centra Lynchburg General Hospital (Va.) | 68 | 1196 | 5.69% |
| Grand Strand Medical Center (S.C.) | 113 | 1853 | 6.10% |
| Rhode Island Hospital (R.I.) | 51 | 818 | 6.23% |
| Mount Carmel East (Ohio) | 80 | 1135 | 7.05% |
| South Shore Hospital (Mass.) | 66 | 852 | 7.75% |
“The frequency at which stents are overused shows that many physicians are struggling to keep up with the evidence,” said Dr. Saini. “To be socially responsible, hospitals need to take a more active role in reducing these unnecessary procedures.”
Methodology
The Lown Institute examined overuse of percutaneous coronary interventions (coronary stent or balloon angioplasty) for 1,773 hospitals with the capacity to perform the procedure. Medicare Advantage and fee-for-service claims were used for 2019 and 2020; only fee-for-service claims were included for 2021 as Medicare Advantage claims were not available.
Stents were defined as meeting overuse criteria for patients with a diagnosis of ischemic heart disease at least six months prior to the procedure, excluding patients with a diagnosis of unstable angina or heart attack within the past two weeks, and excluding patients who visited the emergency department over the past two weeks.
Total Medicare spending on low-value stents was calculated using Medicare’s per-procedure cost of $10,615, the most frequent procedure code used for PCI in our analysis. Of this cost, $9,015 is paid by Medicare and $1,600 is paid by beneficiaries for fee-for-service Medicare patients. Our cost estimate assumes that the cost of stents for Medicare Advantage patients is similar to beneficiaries in traditional Medicare.
Only hospitals performing above the national average volume of total stents were considered for the top and bottom lists.
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SEE ALSO
- The best and worst hospital in each state for stent overuse
- Summary of research on stent overuse
About the Lown Institute
The Lown Institute is an independent think tank that conducts bold and uncompromising research and advocates for a just and caring system of health. The Lown Institute Hospitals Index for Social Responsibility is a signature project of the Institute and features measures never used before like racial inclusivity, avoidance of overuse, and pay equity.
Contact
Aaron Toleos, Lown Institute, (978) 821-4620, atoleos@lowninstitute.org