Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration

Abstract

ImportanceWithin the Veterans Health Administration (VA), the use and cost of low-value services delivered by VA facilities or increasingly by VA Community Care (VACC) programs have not been comprehensively quantified.ObjectiveTo quantify veterans’ overall use and cost of low-value services, including VA-delivered care and VA-purchased community care.Design, Setting, and ParticipantsThis cross-sectional study assessed a national population of VA-enrolled veterans. Data on enrollment, sociodemographic characteristics, comorbidities, and health care services delivered by VA facilities or paid for by the VA through VACC programs were compiled for fiscal year 2018 from the VA Corporate Data Warehouse. Data analysis was conducted from April 2020 to January 2022.Main Outcomes and MeasuresVA administrative data were applied using an established low-value service metric to quantify the use of 29 potentially low-value tests and procedures delivered in VA facilities and by VACC programs across 6 domains: cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and other procedures. Sensitive and specific criteria were used to determine the low-value service counts per 100 veterans overall, by domain, and by individual service; count and percentage of each low-value service delivered by each setting; and estimated cost of each service.ResultsAmong 5.2 million enrolled veterans, the mean (SD) age was 62.5 (16.0) years, 91.7% were male, 68.0% were non-Hispanic White, and 32.3% received any service through VACC. By specific criteria, 19.6 low-value services per 100 veterans were delivered in VA facilities or by VACC programs, involving 13.6% of veterans at a total cost of $205.8 million. Overall, the most frequently delivered low-value service was prostate-specific antigen testing for men aged 75 years or older (5.9 per 100 veterans); this was also the service with the greatest proportion delivered by VA facilities (98.9%). The costliest low-value services were spinal injections for low back pain ($43.9 million; 21.4% of low-value care spending) and percutaneous coronary intervention for stable coronary disease ($36.8 million; 17.9% of spending).Conclusions and RelevanceThis cross-sectional study found that among veterans enrolled in the VA, more than 1 in 10 have received a low-value service from VA facilities or VACC programs, with approximately $200 million in associated costs. Such information on the use and costs of low-value services are essential to guide the VA’s efforts to reduce delivery and spending on such care.

Error in Key Points

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veterans at risk are instead prostate-specific antigen testing for men aged 75 years or older (26.5 [34.9] per 100 male veterans aged ≥75 years), head imaging for syncope (19.1 [47.3] per 100 veterans with syncope), and preoperative chest radiography (16.3 [52.4] per 100 veterans undergoing selected surgeries).We apologize for these errors and appreciate the opportunity to provide corrected data. 2 We have reviewed the complete article and supplement and can confirm that there are no other errors.

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“…We apologize for these errors and appreciate the opportunity to provide corrected data. 2 We have reviewed the complete article and supplement and can confirm that there are no other errors.…”

Programming Error and Incorrect Denominators in a Study of Low-Value Health Services

“…To the Editor On behalf of my coauthors, I write to report errors that occurred in our Original Investigation, “Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration,” that was published online first on July 5, 2022, and in the August 2022 issue of JAMA Internal Medicine .…”

Programming Error and Incorrect Denominators in a Sensitivity Analysis

“…In the Original Investigation, “Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration,” that was published online first on July 5, 2022, and in the August 2022 issue of JAMA Internal Medicine , a programming error resulted in the use of incorrect service-specific denominators for the rates reported in eTable 4 in the Supplement. Corrections have been made to eTable 4 and the related text in the Results section of the article.…”