Regional Gaps in Orthopedic Care for Vets: How to Avoid Unnecessary Surgery

For veterans, orthopedic care varies by region. Learn to spot "low-value" procedures like vertebroplasty and advocate for evidence-based care to avoid

Imagine this: you're a veteran dealing with back pain or joint issues, and you're seeking help. You might think your diagnosis is the main factor determining your treatment. But sometimes, your zip code can be even more influential.

Recent data shows that "low-value" orthopedic procedures – surgeries or injections that science proves offer little to no real benefit for specific conditions – are performed up to five times more often in some areas than in others. That's a huge difference. To make sure you get the care that actually works, you need to know how to tell the difference between necessary surgery and an intervention that might just bring more risk than reward.

Location Matters: There's a big regional gap in how often veterans get procedures like vertebroplasty, especially for spinal fractures that aren't even causing symptoms.
"Low-Value" Defined: These are medical services that offer minimal clinical benefit, could cause harm, or simply cost too much without a good reason.
The "Postcode Lottery": Variations in care often come down to local hospital practices and what doctors prefer, not what's best for the patient.
Advocacy is Key: Asking for evidence-based alternatives can help you steer clear of surgical risks you don't need.

## The Problem: Why Your Address Can Change Your Treatment It's a tough pill to swallow, but it's true: two veterans with identical spinal imaging can walk into two different VA clinics and leave with totally different treatment plans. Research looking at Medicare data and veteran care patterns shows huge "geographic variations" in how orthopedic services are delivered.

The National Institutes of Health (NIH) and other health policy experts have been tracking "low-value care" for a long time. These are procedures that clinical trials have shown are no better than a placebo or simpler treatments, like physical therapy, for certain situations. Even so, thousands of these procedures still happen every year. When care differs so much from one region to the next, it's a sign that treatment isn't always based on the latest science. Instead, it's often dictated by a "this is how we've always done it here" mindset at certain medical centers. This puts *you* at risk for surgical complications, long recovery times, and medical bills, all without a guarantee of feeling better.

*Understanding regional differences in care can help you make smarter choices about orthopedic surgery.*

5 Steps to Avoid Low-Value Orthopedic Care

### 1. Know the Common "Low-Value" Procedures Not every orthopedic surgery is low-value, but some pop up frequently in research as procedures to question. Take vertebroplasty, for example—that's when bone cement is injected into a fractured vertebra. It's often flagged as low-value if you have no pain or if the fracture isn't new. Other procedures that often spark debate include knee arthroscopy for degenerative arthritis (the normal "wear and tear" kind) and certain types of subacromial decompression for shoulder pain.

Physical Therapy (PT): Specific exercises to make your joints more stable.
Anti-inflammatory Management: This should always be supervised by a doctor.
Lifestyle Changes: Things like managing your weight or adjusting your workspace.

If a surgeon immediately pushes for surgery for a condition that isn't an emergency, without even trying these steps first, that's a warning sign.

"What does the current research say about how well this procedure works long-term compared to physical therapy?"
"What are the specific risks, and how many patients with my exact situation actually see a big improvement?"

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"What happens if we wait six months and stick with non-surgical treatment?"

### 4. Get a Second Opinion Outside Your Local Area Because care can vary so much by region, getting a second opinion from a doctor in the same town might just give you the same biased answer. If you can, try to see a specialist at a major academic research hospital or a VA facility in a different region. This helps you break free from any local patterns of over-treatment.

### 5. Read Your Imaging with a "Grain of Salt" As we get older, our MRIs and X-rays are naturally going to show "abnormalities"—things like bulging discs or thinning cartilage. Often, these are just "wrinkles on the inside," normal signs of aging that aren't actually causing your pain. A high-value provider treats *you*, the patient, not just a picture of your insides. If a doctor suggests surgery purely because an MRI looks "messy," proceed with caution.

## What the Research Says Recent studies in journals like *JAMA* and reports from outlets like MedPage Today show that the differences in orthopedic care for veterans aren't tied to how severe their conditions are. Instead, the "intensity" of care is often higher in places with more specialists and fewer primary care doctors acting as gatekeepers.

The research suggests that for many orthopedic issues, simply "watching and waiting" often leads to similar results as surgery after two years. The big difference? "Watching and waiting" costs a lot less and has zero surgical risk. Here's the part most people miss: this research looks at large groups of people. Individual cases of trauma or acute injury absolutely still need surgery. The trick is telling the difference between an elective procedure for everyday "wear and tear" and a necessary one for "structural failure."

*Focusing on overall wellness and physical therapy can often mean you won't need invasive orthopedic procedures.*

Thinking "Newer" or "More Expensive" Equals "Better": Just because a procedure uses a robot or a fancy new type of cement doesn't mean it will work better long-term than traditional exercise.
Ignoring the Placebo Effect: Surgery can have a powerful placebo effect. You might feel better for a few months because of the "prestige" of the intervention, only to have the pain come back because the real problem wasn't fixed.
Not Being Honest About All Your Symptoms: Sometimes patients downplay their ability to move, which can lead doctors to believe surgery is the only way forward. Be honest about what you *can* still do.

Choosing Wisely: This initiative from the ABIM Foundation offers lists of "Things Physicians and Patients Should Question." They have a very helpful section specifically for orthopedics that's great for veterans.

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The VA Move! Program: If your joint pain is made worse by your weight, this internal VA resource provides support to reduce the load on your joints. Often, this can make surgery unnecessary.
Wearable Activity Trackers: Even a simple pedometer or smartwatch can help you and your physical therapist track your "functional recovery"—objective proof that you're improving without surgery.

FAQ

### What exactly is "low-value" care? Low-value care refers to medical tests or treatments that provide little benefit to the patient. They might even cause harm or lead to unnecessary costs. In orthopedics, this often means doing surgery for a condition that would have healed on its own or with physical therapy.

### Why does where I live change the surgery I get? Medical "cultures" can develop in different regions. If a prominent surgeon in a city favors a certain procedure, they often train other local doctors to do the same. This creates a regional bubble where that procedure becomes the local "standard," even if national guidelines suggest something else.

### Is vertebroplasty always a bad idea? No, absolutely not. For patients experiencing intense, debilitating pain from a *new* spinal fracture who haven't responded to other treatments, it can be a useful tool. It becomes "low-value" when it's done on veterans who aren't in pain or who have stable, older fractures.

### How can I tell if my doctor is suggesting a low-value procedure? Ask about the "Number Needed to Treat" (NNT). This is a scientific statistic that tells you how many people need to have the surgery for *one* person to see a significant benefit. If the NNT is high, the procedure might be low-value for your specific situation.

### Does the VA cover second opinions? Yes, veterans generally have the right to ask for a second opinion within the VA system. If you're worried about a surgical recommendation, talk to your primary care physician or a patient advocate about seeing a different specialist.

## Call to Action Tonight, take 10 minutes. Go to the Choosing Wisely website and research any procedure your doctor has suggested. Print out their list of questions and bring them to your next orthopedic appointment. It's a simple step that can make a huge difference.

## Conclusion The big differences in orthopedic care for veterans across different regions should be a wake-up call. You need to be your own best advocate. The VA provides excellent care, but the "postcode lottery" of low-value services means you have to stay sharp. By asking smart questions, prioritizing physical therapy, and understanding that imaging doesn't always tell the whole story, you can make sure your treatment plan is based on solid science, not just your address.

*This article is for general information and is not medical advice. Talk with your doctor before making changes, especially if you have a health condition or take medication.*

Source inspiration: MedPage Today