A study of Medicare claims for veterans aged 65 and older found striking geographic variation in how often five low-value orthopedic services were performed. The services—vertebroplasty, spinal fusion, spinal injections, advanced spinal imaging, and knee arthroscopy—were classified as low-value only when clinical records matched published criteria indicating likely harm outweighed benefit. In some hospital referral regions, rates of these procedures were more than ten times higher than in others, with very-high-rate regions seeing up to 42 procedures per 100 enrollees for vertebroplasty alone.
The analysis, published in JAMA Network Open, used fee-for-service claims from 2017 to 2022. The authors found no clear regional pattern: a region with a high rate of one low-value service did not tend to have high rates of others. Correlation coefficients between service types were weak, ranging from -0.25 to 0.22.
Because utilization patterns differ by procedure, the researchers argue that broad, one-size-fits-all interventions may be ineffective. They call for further study to link procedure-specific variation to spending and outcomes, and they suggest targeted approaches such as prior authorization or network design tailored to individual low-value services.