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Analysis turned up 200,000 unneeded procedures costing Medicare $2 billion over 3 years

by Cheryl Clark, MedPage Today

October 8, 2025

The Lown Institute called out dozens of hospitals for performing unnecessary surgeries on Medicare beneficiaries with low back pain, putting patients at risk of serious complications with no evidence of clinical benefit.

Its analysis focused on high-volume hospitals that performed at least 500 spinal fusion/laminectomy or vertebroplasty procedures over a 3-year period — finding more than 200,000 unnecessary procedures amounting to about $1.9 billion in wasted Medicare spending during that time.

“We’re not doing this just to draw attention to the fact that there is unnecessary surgery,” Lown president Vikas Saini, MD, told MedPage Today. “We’re doing it to track how much, so people who want to do something about it have a guideline.”

As for the doctors who are performing these unnecessary procedures, Saini said there are “true believer” surgeons who insist that the procedure can benefit their patients despite a lack of evidence, “and there are those who are more skeptical. … But let’s be magnanimous and say that all of this comes from a place of wanting to help, and hope that it will help.”

“But if we’re really going to have a reliable, effective, and affordable healthcare system, we can’t just base it all on a hope and a prayer,” he said. “It has to be based on evidence. Hope is easy to have, but in the end, it doesn’t solve the problem.”

The report also noted the high rate of complications from these procedures. Some 18% of spinal fusion procedures result in infection, blood clots, stroke, pneumonia, heart and lung problems, and in some cases, death.

The Lown Institute’s list was taken from Medicare data. The hospitals with the highest rates of spinal fusion/laminectomy overuse are Mount Nittany Medical Center in Pennsylvania (57.2% of 505 procedures), Concord Hospital in New Hampshire (39.5% of 517 procedures), and Lutheran Hospital of Indiana (38.6% of 1,232 procedures).

The hospitals with the highest rates of vertebroplasty overuse included Kettering Health Miamisburg in Ohio (56.1% of 578 procedures), Shannon Medical Center in Texas (54.6% of 694 procedures), and St. Elizabeth Florence Hospital in Kentucky (50.1% of 668 procedures).

The report also applauded hospitals with the lowest rates of these procedures. Avala Hospital in Louisiana, Northwest Specialty Hospital in Idaho, and Baylor Surgical Hospital at Las Colinas in Texas all had spinal fusion/laminectomy overuse rates of 1.2% or lower. Metrohealth Medical Center in Ohio, Harborview Medical Center in Washington, and the Mayo Clinic Health System-La Crosse were among 11 hospitals with no vertebroplasty overuse.

The report also highlighted enormous state variation in rates of overuse of these procedures. California, Florida, Texas, and Pennsylvania had the highest amount of overuse of spinal fusion procedures, with at least 5,000 unnecessary procedures in each state. Texas, Florida, and Ohio had the highest volume of vertebroplasty overuse with at least 6,000 unnecessary procedures in each of those states.

Spinal fusion/laminectomy procedures were considered overused when performed for low back pain, but excluded patients with radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain, or scoliosis.

Spinal fusion-only procedures were not considered overused when performed for stenosis with neural claudication and spondylolisthesis. Laminectomy-only interventions were not considered overused when performed in patients with stenosis who had neural claudication.

Vertebroplasty procedures were considered overused when performed in patients with spinal fractures caused by osteoporosis, but the list excluded patients with bone cancer, myeloma, or hemangioma.

The Medicare data included fee-for-service patients’ procedures from 2021 to 2023 and Medicare Advantage patients’ procedures from 2020 to 2022. Procedures performed on Medicare beneficiaries under age 65 were not included.

Saini said the report concentrated just on those hospitals that performed at least 500 of these procedures. For the spinal fusion/laminectomy analysis, 466 hospitals were evaluated, and for vertebroplasty, 625 hospitals were included.  He said these procedures are extremely expensive, costing $14,500 for spinal fusion and $4,200 for vertebroplasty.

Asked what efforts he thinks will reduce the number of these unnecessary back pain procedures, Saini suggested federal oversight, such as the WISeR (Wasteful and Inappropriate Service Reduction) model, could have a larger role, perhaps with more targeted prior authorization requirements or guidelines.

“There’s no way we can replace clinical judgment of the physician in the exam room,” Saini said. “We can’t have the federal government practicing medicine.”

But a lot of clinicians “just aren’t with the program and some of them will argue with you until they’re blue in the face that the data just doesn’t refute the way they practice,” he said, noting the saying, “It’s hard to get somebody to understand something when their salary depends on them not understanding.”

February 8, 2024
Annie Pierce, UC San Diego

Avid pickleball player Carole Harland says doing dynamic warmups and stretching pre-game is a key to staying injury-free on the court.  America’s fastest-growing sport with the silly name – pickleball – continues to lure new players onto courts in droves. But before hopping into the game, UC San Diego Health physical therapists recommend acing a pickleball pre-game routine to help keep injuries at bay. 

“It’s a fun and addictive sport that you can pick up easily and immediately start playing,” said Aaron Cortez, DPT, physical therapist at UC San Diego Health who has seen an uptick in pickleball injuries among his patients. “Yet it’s a fast-moving game with sudden starts and stops – so it’s easy to get injured if you haven’t run or moved that quickly in years, or maybe even decades.”

“It’s crucial to prepare yourself for those explosive movements before stepping foot onto the court,” he said, adding that the sport is particularly popular among older adults.

Pickleball, a mash-up of ping-pong, tennis and badminton, has clinched the top spot as the fastest growing sport in the country for three years running, with 8.9 million players in the United States in 2023, according to the Sports & Fitness Industry Association, up from 4.8 million in 2022. That number is expected to surge beyond 20 million this year. 

With celebrities from Tom Brady to Leonardo DiCaprio heightening the hype of the game, its unprecedented growth is also causing a steep surge in injuries. Pickleball injuries generated more than $350 million in medical costs in 2023, as reported by Bloomberg, citing research by UBS analysts. The analysts estimated there would be more than 66,750 emergency department visits and 366,000 outpatient visits from pickleball in 2023, based on research from a Journal of Emergency Medicine study about pickleball and tennis-related injuries. The most common types of injuries reported are sprains, strains and fractures, and patients aged 50 or older account for 90% of the injuries. 

During the pandemic, pickleball’s popularity skyrocketed when people discovered they could escape lockdown by learning to play a fun new game while staying socially distanced outdoors. But why all the injuries?  Kenneth Vitale, MD, a physical medicine and rehabilitation physician at UC San Diego Health, said many pickleball players already have baseline arthritis due to their age.

“When you have arthritis and then further aggravate it with twisting or trauma, the arthritis can flare up. Also, ‘picklers’ are notorious for not warming up and for continuing to play through an injury, which can progress their arthritis and eventually require joint replacement surgery,” Vitale said.

Relishing pre-game preparation

Although the growing number of injuries are causing quite a racket, pickleball addicts say they’re not about to shy away from the court. Carole Harland said it was love at first swing when a friend invited her to play pickleball seven years ago. She had been on a weight loss and exercise journey, going to the gym three days a week and walking. 

“But once I discovered pickleball that was it. I dropped the gym and just started playing pickleball nonstop. It’s a game where you can just jump in – the hardest part is keeping score and staying out of the ‘kitchen,’” Harland said with a laugh, referring to the non-volley zone of a pickleball court.  Harland had suffered with knee arthritis for years and underwent a full knee replacement in May 2023. She teamed up with Cortez for physical therapy to help rebuild her strength and agility before returning to the court.

“Through physical therapy, my range of motion has improved, and I’ve gradually been able to increase how often I can play,” said Harland, who also teaches pickleball introductory classes at Poway Adult School. “Doing dynamic warm-ups and stretching is really important because your body has to be prepared and ready for the quick movements.”

Cortez said Harland’s newfound respect for prehab exercises has been the key to both her recovery and keeping her injury free post-surgery. To help others do the same, Cortez and Chris Rudd, DPT, physical therapist at UC San Diego Health, have served up a series of prehab exercises to help prepare both novice and seasoned players alike for the explosive movements of the sport.

An avid pickleball player himself, Cortez says there’s a lot to love about the game. With a good warm-up, wearing the correct shoes (tennis, not running shoes) and refraining from straining to return a ball or running backwards, pickleball can be a great way to burn calories and lead an active life.

“It checks a lot of boxes for people of all ages and backgrounds, blending social and physical activity,” Cortez said. “There’s never been a sport quite like it that has such an intergenerational component where you have teens and seniors playing together. Plus, the average 150-pound person can burn 400 to 500 calories an hour, so it can be a great workout.”

Warming up is a big dill

Going from the couch to the court is a recipe for disaster, said Cortez and Rudd. Yet that’s what many pickleball players expect their bodies to do. Instead, begin by warming up the body with jumping jacks, jogging or another cardiovascular activity pre-game.

Next, focus on functional movements instead of static movements. Doing forward, reverse and lateral lunges can help prepare the legs and joints for the variety of movements during play. Warming up the shoulders, wrists, ankles and Achilles tendons are also key, along with doing planks for core stability and strength. 

“It’s also important to play smart – ideally you shouldn’t be playing multiple days in a row, because that can cause overuse injuries. You want to gradually ramp up to the activity and not suddenly become obsessed, because the body just isn’t used to that level of repetition,” Cortez said, adding that cross training, balance and flexibility training are also recommended. 

Harland said a great way to avoid injuries is to take an introductory class instead of learning the game on the fly.  “If you start with the foundation of learning the basics and learning what not to do – like running backwards – you won’t develop bad habits,” she said. “Pickleball is a very social, family-oriented game where there’s just so much laughter and fun. I don’t ever plan on giving it up!”

Downsizing your home in retirement might seem like the most straightforward way to cut costs and access the home’s equity. With rising property taxes, utility bills and home maintenance expenses, it’s unsurprising that a big house can feel more like a burden than a haven in your golden years. But is downsizing the best option?

While moving to a smaller space can benefit some, it’s not the only way to improve your financial flexibility in retirement. From reverse mortgages to life insurance settlements, several retirement cash flow options are worth exploring before listing your home. Below, we go over what to consider before moving – and alternatives if you decide to stay put.

SHOULD YOU DOWNSIZE IN RETIREMENT? 5 QUESTIONS TO ASK

Before making retirement housing decisions, consider whether downsizing aligns with your financial and lifestyle goals. These questions can help you assess your options:

• Do you truly need the space you have now? Unused rooms and high maintenance demands may signal it’s time to simplify. Downsizing could free you from upkeep you no longer want or need.
• Will you actually save money after the move? Factor in transaction costs, moving expenses and new home prices. Downsizing doesn’t always lower your monthly costs, especially in high-demand areas.
• Will a new home improve your lifestyle? Think about access to family, medical care or walkable amenities. The right move can enhance your day-to-day comfort and convenience.
• Are you emotionally ready to let go? Letting go of a long-time home can be harder than expected. Make sure the timing feels right for you and your family.
• Have you considered other retirement cash flow options? From HELOCs to life insurance settlements, there may be ways to increase income or liquidity without moving. Downsizing for retirement income isn’t your only path forward.

DOWNSIZING: THE PROS AND POTENTIAL PAYOFF

The main appeal of downsizing is the chance to unlock equity from your home and reduce ongoing costs. Here’s a closer look at these advantages and more.

• Free up retiree home equity: If you own your home outright or have significant equity, selling could provide a lump sum to supplement retirement savings, cover medical costs or delay Social Security benefits.
• Lower housing costs: Smaller homes often mean lower property taxes, utility bills, homeowners insurance and upkeep costs. This frees up room in your monthly budget.
• Be closer to support: Some retirees move closer to family, doctors or age-friendly amenities. It opens the door to better healthcare access, a more favorable tax environment, walkable communities and public transit.
• Simplify daily life: A smaller, more accessible home can reduce physical strain and daily responsibilities, particularly for retirees with mobility concerns. It can also be a fresh start, physically and emotionally.
• Avoid future upkeep: As homes age, so do their systems. Downsizing can help avoid hefty repair bills for roofs, HVAC systems and plumbing.

DOWNSIZING: THE CONS AND HIDDEN COSTS

For all its potential, downsizing your home in retirement comes with trade-offs that are easy to overlook until you’re in the thick of it. Here are a few downsizing retirement pitfalls to consider.

• Upfront expenses can be high: Selling your home in retirement and buying another involves agent commissions, legal fees, moving costs and potentially new furniture or renovations. These costs can eat into your proceeds.
• Market conditions matter: In some areas, downsizing doesn’t mean downgrading your budget. Per-square-foot costs can be higher for smaller homes or single-story properties in high-demand retirement markets.
• Loss of space and flexibility: Hosting family gatherings and out-of-town guests or storing hobbies and keepsakes becomes harder in a smaller space. You may lose the flexibility your current home provides.
• Emotional strain: Selling a family home can be an emotional hurdle, especially if it’s filled with memories.

OTHER WAYS TO UNLOCK VALUE IN RETIREMENT

If downsizing doesn’t feel like the right fit, or if you want to avoid a major move, there are several alternatives to downsizing that can help improve your retirement cash flow:

• Home equity lines of credit (HELOCs): A HELOC allows you to borrow against your home’s value while keeping it. However, it requires ongoing payments and strong credit.
• Reverse mortgages: These can offer steady cash flow, but fees and interest can reduce long-term equity.
• House hacking for retirees: Renting out a room, basement or guesthouse can generate retirement income with minimal disruption.
• Life insurance settlements: If you no longer need your policy or premiums have become unaffordable, selling it may provide a lump sum worth significantly more than the surrender value. This can be a low-disruption way to access value from an underused asset.
• Asset reallocation: Revisiting your investment portfolio or consolidating accounts can reveal untapped resources or reduce fees, improving income sustainability.
• Important: Many strategies to unlock retiree home equity, such as downsizing, reverse mortgages or life insurance settlements, can increase liquid assets. Consult a financial advisor to avoid unintended eligibility issues if you rely on Medicaid or other need-based assistance.

WHEN DOWNSIZING ISN’T A CHOICE

Not every retiree downsizes by choice. Sometimes it’s a decision driven by rising costs, unexpected health issues, or a change in income. A house that once felt comfortable and manageable may start to feel overwhelming – physically, financially or both. In these situations, downsizing can feel like a loss, especially when the move is about making ends meet rather than starting fresh.

That’s why it’s worth exploring all your options before packing up. There may be other ways to improve your cash flow, like tapping into home equity or selling a life insurance policy you no longer need. If downsizing feels more like a last resort than a new beginning, those alternatives might help you stay in the home you love a little longer.

RIGHTSIZING YOUR RETIREMENT PLAN

Downsizing can offer real benefits, especially for retirees looking to simplify or improve their finances. But other retirees prefer to stay in their homes and explore options like HELOCs, partial rentals or life settlements. These can offer similar results with less disruption. Whether you adjust your square footage or rethink your finances, take time to explore all your options. A strong retirement plan should fit your life, not vice versa.

Retirement is the end of one chapter – your work life – and the beginning of another: Your new life. For some seniors, retirement is an opportunity to travel the world. For others, it’s about having the time to pick up old hobbies or try something new. But retirement offers an even bigger benefit: the chance for lifelong learning after retirement. Not sure where to get started? Here are some ways to continue your education after retirement.

BOOK CLUBS

Book clubs are a great way to meet new people and learn new things. Community centers or local coffee shops may have ads for neighborhood book clubs, or you can start your own with just one or two friends. These groups offer opportunities to socialize and the chance to expand your horizons. Plus, you’d be ahead of the curve. According to data from YouGov, 46% of Americans didn’t read a book in 2023. Book clubs offer lifelong learning for seniors, one page at a time.

ADULT LEARNING CENTERS

Adult learning centers are another option for education in retirement. You may have seen advertisements for these centers or passed by them in your neighborhood, and you’ve probably asked yourself, “What are they teaching in there?” The answer is just about anything. You could enroll in senior learning programs that focus on history, science, acting or financial management, to name a few. Plus, learning centers regularly update their course catalogs so you never run out of new options.

ONLINE CLASSES

If you prefer to learn in the comfort of your own home, consider online classes. Platforms such as Coursera, Khan Academy and edX all offer a host of lifelong learning programs for seniors. You can learn about computer programming, economics, U.S. history or personal finance. Some online schools also offer pathways to certification or accreditation if you’re considering a second career (or just want to challenge yourself).

COLLEGE EDUCATION

Want the full education experience? It’s never too late to consider going to college. As noted by NASDAQ, a growing number of U.S. retirees are now returning to college or exploring post-secondary schools for the first time. College offers the dual benefits of huge course selections and built-in social circles to help facilitate lifelong learning for senior citizens.

LEARNING A SECOND LANGUAGE

If you’re considering a trip around the world or have specific countries on your bucket list, why not learn another language? Apps like Duolingo let you start with the basics and build your way up to a working knowledge of languages like French, Spanish, Mandarin or even Norwegian. Many adult learning centers also offer language classes if you prefer in-person learning.

PUBLIC SPEAKING

Terrified of public speaking? You’re not alone – over 75% of people agree it’s a scary prospect. If you’ve decided to push the envelope, however, there are options to boost your confidence. For example, Toastmasters has been helping its members overcome their fear of public speaking since 1924.

COMMUNITY VOLUNTEERING

If you’re interested in learning new things while staying close to home, consider volunteering in your local community. Senior learning opportunities can often be found at local libraries, museums, community centers or charitable organizations such as shelters, food banks and soup kitchens. Volunteering is a great way to meet new people and learn from their experiences, in turn broadening your perspective (and maybe making a few friends along the way).

POTTERY LESSONS

Pottery is growing in popularity for young and old alike. There’s something satisfying about shaping and molding clay and then putting it through the fire (literally) to produce a finished product. Local pottery classes let you work with different materials and use various techniques to create ceramic pieces that last for years or decades. Plus, you get the benefit of a good workout and a class full of like-minded potters.

HOME MAINTENANCE

According to data from the AARP, 77% of older adults want to stay in their homes for as long as possible, rather than moving to a care facility. If home is where your heart is, this is a great opportunity for continuing education in retirement. The more maintenance and repair work you can do around your home, the more you learn and the less you pay for repairs.

Best bet? Start with small projects, such as fixing popped nails or re-caulking seams and windows. YouTube is a great resource for how-to videos, offering everything from in-depth advice to quick overviews that help get you on the right path. The result is a win-win – you get to enjoy your retirement in the comfort of your own home, even as you learn more about keeping it in great shape.

Life insurance plays a significant role in financial planning for seniors who are managing retirement income and long-term care costs. However, many are also starting to wonder if they can turn their life insurance policy into something useful today, rather than just a future benefit for their heirs.

The options on the market can be confusing. The term “reverse life insurance” frequently appears in online searches and conversations. However, the truth is that there is no such product. There is, however, a life insurance payout alternative – a life settlement.

There is no official product called reverse life insurance. You will not find it listed in a policy brochure or offered by insurance companies. But people use the phrase when trying to figure out how to convert a life insurance policy into cash.

Many people searching for reverse life insurance are:

• Looking for ways to get money for retirement
• Paying premiums on a policy they no longer need
• Curious about selling their policy for a lump sum payout

They may have heard from a friend or read online that it’s possible to “cash out” of a life insurance policy, and that’s where the confusion starts. Some assume that reverse life insurance is a formal option, similar to a reverse mortgage, which allows homeowners to convert part of their home equity into cash.

What most people are thinking of is a life settlement. This is a real and regulated financial transaction that allows you to sell part or all of your life insurance policy for a cash payout that you do not have to repay.  A life settlement is a transaction where you sell your life insurance policy to a third party for a lump sum. The payout for a life settlement is typically greater than the policy’s cash surrender value but less than the full death benefit.  Once the policy is sold, the buyer takes over future premiums and receives the death benefit when you pass away.

To qualify for a life settlement, you typically need to:

• Be over age 65
• Have a whole life, universal life or other permanent policy with a death benefit of at least $100,000
• Have held the policy for at least two years (which varies by state)
• Have changes in your health status since you purchased the policy

Let’s take Judy, a 76-year-old with a $250,000 universal life insurance policy. Her children are grown, she is retired, and the premiums are starting to strain her fixed income.  She decides to sell her policy for a $60,000 lump sum payment and rids herself of any future premiums.

This is a much better option than letting the policy lapse or taking the $15,000 surrender value from the insurance company. That’s the power of a life settlement. It turns something you no longer need into cash you can use today.

REVERSE LIFE INSURANCE VS. LIFE SETTLEMENTS: WHAT’S THE DIFFERENCE?

Reverse life insurance and life settlements are often used in the same breath, but they are not the same thing. Think of “reverse life insurance” as a casual term. It’s not a product. It’s more like a search phrase, or a placeholder people use when they are unsure what the real option is. On the other hand, a life settlement is a legitimate, regulated transaction. It involves paperwork, legal review and protections for the seller and buyer.

OTHER TERMS CONFUSED WITH REVERSE LIFE INSURANCE

When people search for ways to get cash from their life insurance, “reverse life insurance” is not the only phrase that causes confusion. There are a few other options that sound similar, but each one works differently:

• Viatical settlement: This is similar to a life settlement but for terminally ill individuals. The payout is often higher, and it is based on the life expectancy of the insured.
• Cash surrender: If you cancel your policy, your insurance company may pay you a surrender value. This amount is usually much lower than what you would get from a life settlement.
• Accelerated death benefit: Some life insurance policies let you access part of the death benefit early if you are diagnosed with a serious illness. This is not a sale, but more like a loan against your coverage.

Each of the options above works in different situations. However, a life settlement usually delivers the highest value when you simply no longer want or need a life insurance policy.