Table 2. Overall Use of Low-Value Services Delivered by Veterans Health Administration (VA) Facilities and in VA Community Care (VACC) Programs in Fiscal Year 2018a.
| Low-value health services by domain | Overall use (VA + VACC settings),b No. | By setting, No. (row %) | ||
|---|---|---|---|---|
| Total | Per 100 veteransc | VA facilities | VACC programs | |
| Cancer screening | ||||
| PSA testing for men aged ≥75 y | 309 731 | 5.9 | 306 317 (98.9) | 3414 (1.1) |
| Colorectal cancer screening for adults aged ≥75 y | 7220 | 0.1 | 6050 (83.8) | 1170 (16.2) |
| Cervical cancer screening for women aged ≥65 y | 4599 | 0.1 | 4496 (97.8) | 103 (2.2) |
| Cancer screening for patients with CKD receiving dialysis | 2082 | 0.04 | 1909 (91.7) | 173 (8.3) |
| Total | 323 632 | 6.2 | 318 772 (98.5) | 4860 (1.5) |
| Imaging | ||||
| Back imaging for patients with nonspecific low back pain | 141 424 | 2.7 | 122 801 (86.8) | 18 623 (13.2) |
| Screening for carotid artery disease in asymptomatic adults | 90 080 | 1.7 | 81 127 (90.1) | 8953 (9.9) |
| Head imaging for uncomplicated headache | 51 333 | 1.0 | 42 340 (82.5) | 8993 (17.5) |
| Head imaging for syncope | 15 606 | 0.3 | 12 255 (78.5) | 3351 (21.5) |
| CT of the sinuses for uncomplicated acute rhinosinusitis | 8908 | 0.2 | 7418 (83.3) | 1490 (16.7) |
| Screening for carotid artery disease for syncope | 7007 | 0.1 | 5114 (73.0) | 1893 (27.0) |
| Imaging for diagnosis of plantar fasciitis | 4745 | 0.1 | 3480 (73.3) | 1265 (26.7) |
| EEG for headaches | 1984 | 0.04 | 1266 (63.8) | 718 (36.2) |
| Total | 321 087 | 6.1 | 275 801 (85.9) | 45 286 (14.1) |
| Preoperative testing | ||||
| Chest radiography | 117 777 | 2.3 | 105 054 (89.2) | 12 723 (10.8) |
| Echocardiography | 14 355 | 0.3 | 12 662 (88.2) | 1693 (11.8) |
| Stress test | 12 830 | 0.2 | 9508 (74.1) | 3322 (25.9) |
| Pulmonary function test | 7044 | 0.1 | 6119 (86.9) | 925 (13.1) |
| Total | 152 006 | 2.9 | 133 343 (87.7) | 18 663 (12.3) |
| Diagnosis and preventive testing | ||||
| PTH measurement for patients with stage 1-3 CKD | 83 664 | 1.6 | 80 459 (96.2) | 3205 (3.8) |
| 1,25-Dihydroxyvitamin D testing in the absence of hypercalcemia or decreased kidney function | 26 849 | 0.5 | 26 451 (98.5) | 398 (1.5) |
| Total or free T3 level testing for patients with hypothyroidism | 24 205 | 0.5 | 22 263 (92.0) | 1942 (8.0) |
| Homocysteine testing for cardiovascular disease | 4878 | 0.1 | 4411 (90.4) | 467 (9.6) |
| BMD testing at frequent intervals | 3460 | 0.1 | 3357 (97.0) | 103 (3.0) |
| Hypercoagulability testing for patients with deep vein thrombosis | 3117 | 0.1 | 2503 (80.3) | 614 (19.7) |
| Total | 146 173 | 2.8 | 139 444 (95.4) | 6729 (4.6) |
| Other procedures | ||||
| Spinal injection for low back pain | 72 659 | 1.4 | 44 435 (61.2) | 28 224 (38.8) |
| Arthroscopic surgery for knee osteoarthritis | 998 | 0.02 | 616 (61.7) | 382 (38.3) |
| Total | 73 657 | 1.4 | 45 051 (61.2) | 28 606 (38.8) |
| Cardiovascular testing and procedures | ||||
| Stress testing for stable coronary disease | 6914 | 0.1 | 5018 (72.6) | 1896 (27.4) |
| PCI with balloon angioplasty or stent placement for stable coronary disease | 3471 | 0.1 | 1450 (41.8) | 2021 (58.2) |
| IVC filters to prevent pulmonary embolism | 1423 | 0.03 | 643 (45.2) | 780 (54.8) |
| Renal artery angioplasty or stenting | 182 | 0.003 | NA | NA |
| Carotid endarterectomy in asymptomatic patients | 37 | 0.001 | NA | NA |
| Total | 12 027 | 0.2 | 7219 (60.0) | 4808 (40.0) |
| Grand total | 1 028 582 | 19.6 | 919 630 (89.4) | 108 952 (10.6) |
Abbreviations: BMD, bone mineral density; CKD, chronic kidney disease; CT, computed tomography; EEG, electroencephalogram; IVC, inferior vena cava; NA, not available; PCI, percutaneous coronary intervention; PSA, prostate-specific antigen; PTH, parathyroid hormone; T3, triiodothyronine.
a
Data are masked to avoid presenting small cell sizes in accordance with our data use agreement with Centers for Medicare & Medicaid Services guidelines.
b
Counts represent low-value health services identified by applying specific criteria.
c
Denominator is 5 242 301 for the full cohort.