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Publication Briefs

Study Shows Low-Value Service Use is Common and Costly among Veterans Enrolled in VA Healthcare

Low-value care – the use of a health service whose harms or costs outweigh its benefits – is a major driver of wasteful healthcare spending. Low-value services affect as many as 43% of those enrolled in Medicare and/or private insurance plans. Studies suggest that low-value care also may be prevalent within VA, extending to Veterans referred to VA Community Care (VACC) providers as a result of the Veterans Choice Program and MISSION Act. This retrospective cross-sectional study sought to quantify Veterans’ overall use and cost of low-value services, including VA-delivered care and VA-purchased community care. Investigators applied an established low-value service metric to quantify the use of 29 potentially low-value tests and procedures in VA facilities and VACC settings across six domains: cancer screening, diagnostic-preventive testing, preoperative testing, imaging, cardiovascular testing, and other procedures. In conjunction with the Health Economics Resource Center (HERC), they also determined cost by applying standardized cost estimates for each low-value service, based upon average national Medicare and private sector reimbursement rates. The study cohort included more than 5 million Veterans who were enrolled in VA healthcare during FY2017 and FY2018, with 32% receiving healthcare services through VACC.


  • Low-value service use is common and costly across a variety of VA services. In this study cohort, 19.6 low-value services per 100 Veterans were delivered by VA facilities or VACC programs in fiscal year 2018, which involved 14% of Veterans at a cost of $205.8 million.
  • The costliest low-value services included spinal injections for low back pain, which cost $43.9M (21% of low-value care spending) and percutaneous coronary intervention for stable coronary disease, which cost $36.8M (18% of low-value care spending). Overall, the most frequently delivered low-value service was prostate specific antigen testing for men aged ≥75, which was also the service with the greatest proportion delivered by VA facilities, at 99%.


  • Findings may serve as a foundation for the development of policies and interventions to more carefully monitor and ultimately reduce low-value care delivered by VA facilities – and inform the development of value-based standards for non-VA clinicians who participate in VACC programs.


  • The extent to which the services identified in this study are truly inappropriate for a given individual is not clear and may differ across populations.
  • Findings do not indicate the relative performance of VA vs. VACC in avoiding low-value care when specific diagnoses or referrals occur in each care setting – an important topic for future research.

This study was funded by HSR&D (IIR 19-089). Drs. Radomski, Zhao, and Thorpe, and Mr. Lovelace are part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP).

Radomski TR, Zhao X, Lovelace EZ, et al., and Thorpe CT. Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration. JAMA Internal Medicine. July 5, 2022; online ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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