Objective:

To evaluate geographic variation across hospital referral regions (HRRs) for 5 orthopedic low-value services (LVSs) and examine correlations among regional service rates in a cohort of veterans enrolled in traditional Medicare.

Approach:

• Study Design: Cross-sectional study using 2017 to 2022 Medicare fee-for-service claims to identify veterans aged 65 and older with orthopedic surgeon visits.
• Data Analysis: Utilized established claims-based algorithms to quantify 5 orthopedic procedures considered low-value and derived HRR-level rates per 100 enrollees.
• Statistical Methods: Evaluated cross-service clustering with enrollee-weighted Pearson correlations and calculated reliability-corrected correlations in sensitivity analyses.

Key Findings:

• Orthopedic LVS prevalence varied geographically across 306 HRRs serving 1,589,218 enrollees.
• Southern HRRs had high rates of back imaging but low rates of spinal fusion, while western HRRs showed the opposite pattern.
• Pairwise correlations among the 5 LVSs were consistently low, with r values ranging from -0.21 to 0.20.

Limitations:

• Results may not be generalizable to nonveteran populations.
• The study did not explore underlying factors contributing to geographic variation in LVS frequency.
• Correlations for outpatient services may differ from those observed at the HRR level.