Low-Value Care Common for Veterans, Costly for VA

The use of low-value services was common among veterans and resulted in total costs of over $200 million for the Veterans Health Administration (VA) in 2018, according to findings published in JAMA Internal Medicine.

“Low-value care, defined as the use of a health service whose harms or costs outweigh its benefits, is a major driver of wasteful health care spending and exerts negative physical, psychological, and financial harms upon patients,” researchers said. “The objective of this study was to quantify veterans’ overall use and the cost of low-value services, including VA-delivered care and VA-purchased community care.”

The cross-sectional study involved 5.2 million veterans across the United States, of mean age 62.5 years and predominantly male (91.7%). Additional data indicated 68% of participants were non-Hispanic White. Researchers gathered information for the 2018 fiscal year using the VA Corporate Data Warehouse and conducted analysis from April 2020 to January 2022.

Findings showed 32.3% of veterans received any type of care through VA community care (VACC) programs. Low-value care, specifically, was provided for 13.6% of participants in VA facilities or VACC programs—a rate of 19.6 services per 100 veterans.

The total cost of low-value services was $205.8 million in 2018, study authors said.

The following were the most frequently used individual low-value services:

• prostate-specific antigen testing for men at least 75 years of age (5.9 per 100 veterans);
• back imaging for nonspecific low back pain (2.7 per 100 veterans); and
• preoperative chest radiography (2.3 per 100 veterans).

Spinal injections for low back pain and percutaneous coronary intervention for stable coronary disease resulted in the highest costs, at $43.9 million (21.4% of spending) and $36.8 million (17.9% of spending), respectively.  

“The findings…suggest that low-value care is common and costly across a variety of services within the VA,” study authors concluded. “Our findings may provide a foundation for the development of policies and interventions to more carefully monitor and ultimately reduce low-value care delivered directly by VA facilities and inform the development of value-based standards for non-VA clinicians who participate in VACC programs.”

Reference:
Radomski TR, Zhao X, Lovelace EZ, et al. Use and cost of low-value health services delivered or paid for by the Veterans Health Administration. JAMA Intern Med. Published online July 5, 2022. doi:10.1001/jamainternmed.2022.2482