Veterans' Use of Questionable Orthopedic Procedures Varies Sharply by Region
An analysis of Medicare data found that rates of certain low-value orthopedic procedures among veterans differed by as much as tenfold across hospital referral regions. High use of one such service did not predict high use of another in the same area. The authors suggest that procedure-specific policy tools like prior authorization might help reduce unnecessary care.
The study tracked five orthopedic services deemed low-value for specific clinical presentations: vertebroplasty, spinal fusion, spinal injections, advanced spinal imaging, and knee arthroscopy. Claims were only classified as low-value when patient records matched published criteria—for instance, vertebroplasty was considered appropriate only when compression fractures remained unhealed and conservative treatments had failed.
The analysis drew on Medicare fee-for-service claims from 2017 through 2022 for veterans aged 65 and older who had seen an orthopedic surgeon. Notably, regions with high utilization of one procedure showed no corresponding pattern for others, suggesting local practice traditions rather than systemic overuse. The authors propose procedure-specific interventions such as prior authorization to curb unnecessary care.
This research could inform how policymakers target wasteful healthcare spending, particularly within the veterans' system. If regional variations reflect provider preferences rather than patient needs, prior authorization or insurance design changes may reduce unnecessary procedures, lowering costs and sparing patients from avoidable risks. However, such tools must be carefully calibrated to avoid delaying appropriate care, and the findings may prompt further investigation into how these patterns affect overall spending and outcomes.