• Illinois: According to a new study published in JAMA Internal Medicine, older men with prostate cancer have been increasingly overtreated in the last 20 years. For the study, researchers analyzed data from 243,928 men in the Veterans Affairs (VA) health system who had received a diagnosis of clinically localized prostate cancer between January 2000 and December 2019. The mean age was 66.6 years. Among these patients, 20.5% had an estimated life expectancy of less than 10 years, and 4.7% had a life expectancy of less than 5 years based on age-adjusted Prostate Cancer Comorbidity Index scores. Overall, the researchers found that the rate of aggressive treatment increased by an absolute 23% among men with an estimated life expectancy of less than 10 years and intermediate-risk cancers and by 29% among those with a life expectancy of less than 5 years and high-risk cancers. However, aggressive treatment declined in men with low-risk prostate cancer. "The fact that such overtreatment exists in a non–fee-for-service setting such as the VA (which has been a national leader in reducing overtreatment based on disease risk) suggests that the problem of overtreatment of men with limited [life expectancy] has not been solved in the active surveillance era, despite increasing numbers of men with low-risk [prostate cancer] receiving active surveillance," the researchers wrote. (Bassett, MedPage Today, 11/11)
• Massachusetts: According to a new analysis from the Lown Institute, hospitals performed over 200,000 unnecessary back surgeries on Medicare beneficiaries over a three-year period. In the analysis, researchers examined Medicare fee-for-service and Medicare Advantage claims for common back surgeries, such as spinal infusion, laminectomy, and vertebroplasty, over three-year periods. Roughly 14% of spinal infusions and laminectomies met the criteria for overuse, indicating that patients with low back pain did not have certain diagnoses, like trauma or scoliosis, that would warrant surgery. Around $2 billion was spent on these "low value" procedures while patients were put at risk of poor health outcomes, the researchers wrote. Notably, rates of overuse varied significantly between hospitals, ranging from less than 1% to more than 50%. According to Lown Institute president Vikas Saini, the variability is not surprising, but is frustrating in its persistence. "Where you trained and what the norm is for you is often the bigger determinant [of surgery] compared to what the evidence is," he said. (Reed, Axios, 11/14)
• Wyoming: Teton County District Judge Melissa Owens has struck down Wyoming's overall ban on abortion, as well as the state's first-in-the-country explicit ban on the use of medication to end pregnancy. In her ruling, Owens said that abortion bans "will undermine the integrity of the medical profession by hamstringing the ability of physicians to provide evidence-based medicine to their patients." She also ruled that the bans violated a 2012 state constitutional amendment saying that competent Wyoming residents have a right to make their own healthcare decisions. (Gruver, Associated Press, 11/18)

Everyone wants to increase healthcare value, but key tensions make that goal elusive. Consider these tensions along four spectrums: Value in the short term versus long term. Value to the individual versus the larger population. Outputs versus outcomes. Proven strategies versus experimental. With input from over 100 healthcare leaders, we detail the current state of the industry and steps to increase overall healthcare value.