Unnecessary care leads to a lower quality of services that can worsen patient and worker safety and drive up healthcare costs. About 11% of the nation’s health systems are perpetrators of this problem, according to a new study at Johns Hopkins University.

Topping the list was St. Dominic Health Services of Jackson, Mississippi, followed by USMD Health System in Irving, Texas; Community Medical Centers in Clovis, California; and Care New England Health System in Providence, Rhode Island, reported Modern Healthcare.

According to the study, unneeded tests, procedures and screenings are often found among health systems that employ fewer primary care physicians, have higher bed counts, or are investor-owned. For example, the only for-profit health system found to be over-utilizing care was USMD Health System.

"Primary care physicians have a role in coordinating care and making sure that procedures aren't repeated if they've already been done, and that specialists aren't used if it's something that can be managed by primary care doctor," said Dr. Jodi Segal, the lead author and a professor at the Johns Hopkins University School of Medicine.

The authors evaluated 17 services previously categorized as unnecessary at 3,745 hospitals. Among them were MRs for patients with mild traumatic brain injuries, spinal fusions for back pain and pap smears for women over 65. Among their findings, they observed that the more physician groups a health system owned, the more unnecessary care it provided. "As hospitals restructure themselves into larger and larger systems, senior leadership of hospitals will have to own this problem, said Dr. Vikas Saini, president of the Lown Institute, a healthcare think tank that has studied overuse.

In addition, health systems that performed unnecessary services the least were more likely to be academic medical centers, employed more primary care physicians and provided a disproportionate amount of uncompensated care or used integrated delivery networks.

Large not-for-profit health systems such as Allegheny Health System and Houston Methodist also exhibited below-average amounts of unneeded care. Others like Dignity Health of San Francisco and Geisinger in Pennsylvania were ranked as average in this regard.

"Given the immense strain on our [healthcare] system and clinicians over the past two years, identifying practices for de-implementation are even more important to reduce burden on our workforce,” said Rinad Beidas, the director of the Penn Implementation Science Center at the University of Pennsylvania, who was not involved in the research.

Segal and her colleagues excluded children’s hospitals, behavioral health centers, rehabilitation hospitals and psychiatric hospitals. They plan to continue evaluating health systems with average or below-average use of procedures, especially those with characteristics more similar to the biggest overusers, to derive insights that can be shared with peers that have higher usage of unneeded services. Further research into which specialists deliver the services, what kinds of patients receive them and what the reasons are that they do so will also be needed.

While St. Dominic’s Health Services has not fully reviewed the Johns Hopkins study, Scott Kashman, the president of its health services market operation, says "we 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.”

The findings were published in JAMA.

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