ROCHESTER, Minn. -- A ranking of the nation's hospitals from best to worst according to an emerging benchmark for quality control has singled out a half-dozen Midwestern health centers among its top 50.

The list includes one hospital each of the Dakotas and four from Minnesota. With one exception, the hospitals in the spotlight aren't among the highest-profile names in those states.

The facilities were recognized for their effectiveness at not providing services -- those "that offer little to no clinical benefit to patients."

To come up with the new ranking, the Lown Institute Hospitals Index analyzed the rate and volume of 12 "low-value services" in over 3,100 hospitals from across the country.

Lown, a nonpartisan think-tank based in Boston, is dedicated to the reduction of waste and harmful overtreatment within health care. To be eligible, the hospitals had to offer at least four services.

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The "low-value services" under review represented tests and procedures that once were believed to be effective, later found through validated studies as ineffective, and yet continue to be offered anyway.

Lown estimates that between $200-$900 billion is spent each year for care that does not help, all the while exposing patients to side effects and complications.

After analyzing data filed between 2016 and 2018 from a 100% Medicare claims database, the ranking placed six area hospitals in the top 50 for judicious avoidance of low-value care.

  • In Hettinger, N.D., a small community in the southwestern part of the state, West River Regional Medical Center-CAH ranked third in the country.
  • At No. 5, Mayo Clinic Health System Lake City, south of Red Wing, Minn., made the top 10 -- while Mayo Clinic Rochester failed to crack the top 100.
  • Ortonville Area Health Services in central Minnesota ranked 21st, Essentia Health-St. Mary's in Duluth ranked 28th, Monument Health Lead-Deadwood, S.D., ranked 29th, and Olmsted Medical Center in Rochester, Minn., came in at 41st.

A worst-of list for hospitals that provided the most low-value care was dominated by hospitals located in Florida (14) and Texas (10).

Related research from Lown found the highest rates of overuse occurred in "hospitals in the South, for-profit hospitals, and nonteaching hospitals," with no hospitals from the Midwest included in the bottom 50.

As a state, Minnesota performed well, ranking fourth in the nation for avoiding low-value care, followed by South Dakota at No. 5 and North Dakota at No. 12.

Taking aim at the headline-grabbing US News & World Report Best Hospitals rankings, Lown compiled a list showing how the nation's most-respected hospitals fared when it came to avoiding low-value care.

Mayo Clinic Rochester, a perennial No. 1 on the celebrated list, came in 205th, beating its competitor Johns Hopkins (236) but not Cleveland Clinic at No. 58. Cleveland Clinic was the only US News Best Hospital to crack the top 100 in the Lown Institute Index.

The four low-value tests and eight low-value procedures studied in the rankings included arthroscopic knee surgery in patients with runner's knee or osteoarthritis, spinal fusion for low back pain, hysterectomy without a diagnosis of cancer or cancer in situ, and vertebroplasty in patients with spinal fractures caused by osteoarthritis.

The list also included coronary artery stenting in patients with stable heart disease, carotid artery imaging on patients for fainting with no history of other hypertensive nervous or musculoskeletal conditions, carotid endarterectomy on female patients without stroke symptoms or history of stroke, and EEG for recent onset of headache or fainting (excluding patients with seizures).

Renal artery stenting for plaque build-up or high blood pressure was also among the 12 low-value procedures, as was implantation of a device meant to remove clots destined for the lungs known as inferior vena cava filter. Essentia Health Duluth was the number one hospital in the country for avoiding use of inferior vena cava filters.

According to Lown, 64% of hysterectomies, 44% of carotid endarterectomies, and 24% of coronary stent procedures met criteria for overuse nationwide.