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The U.S. spends huge amounts of money on health care that does little or nothing to help patients, and may even harm them. In Colorado, a new analysis shows that the number of tests and treatments conducted for which the risks and costs exceed the benefits has barely budged despite a decade-long attempt to tamp down on such care.

This story also ran on CBS News. It can be republished for free.

The state including the government, insurers, and patients themselves spent $134 million last year on what is called low-value care, according to the report by the Center for Improving Value in Health Care, a Denver nonprofit that collects billing data from health plans across Colorado. The top low-value items in terms of spending in each of the past three years were prescriptions for opiates, prescriptions for multiple antipsychotics, and screenings for vitamin D deficiency, according to the analysis.

Nationwide, those treatments raise costs, lead to health complications, and interfere with more appropriate care. But the structure of the U.S. health system, which rewards doctors for providing more care rather than the right care, has made it difficult to stop such waste. Even in places that have reduced or eliminated the financial incentive for additional testing, such as Los Angeles County, low-value care remains a problem.

And when patients are told by physicians or health plans that tests or treatments arent needed, they often question whether they are being denied care.

While some highly motivated clinicians have championed effective interventions at their own hospitals or clinics, those efforts have barely moved the needle on low-value care. Of the $3 trillion spent each year on health care in the U.S., 10% to 30% consists of this low-value care, according to multiple estimates.

Theres a culture of more is better, said Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design. And more is better is very hard to overcome. Email Sign-Up

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To conduct its study, the Center for Improving Value in Health Care used a calculator developed by Fendrick and others that quantifies spending for services identified as low-value care by the Choosing Wisely campaign, a collaborative effort of the American Board of Internal Medicine Foundation and now more than 80 medical specialty societies.

Fendrick said the $134 million tallied in the report represents just a small piece of the universe of no- and low-value care in Colorado. The calculator tracks only the 58 services that developers were most confident reflected low-value care and does not include the costs of the cascade of care that often follows. Every dollar spent on prostate cancer testing in men over 70, for example, results in $6 in follow-up tests and treatments, according to an analysis published in JAMA Network Open in 2022.

In 2013, Childrens Hospital Colorado learned it had the second-highest rate of CT abdominal scans a low-value service among U.S. childrens hospitals, with about 45% of kids coming to the emergency room with abdominal pain getting the imaging. Research had shown that those scans were not helpful in most cases and exposed the children to unnecessary radiation.

Digging into the problem, clinicians there found that if ER physicians could not find the appendix on an ultrasound, they swiftly ordered a CT scan.

New protocols implemented in 2016 have surgeons come to the ER to evaluate the patient before a CT scan is ordered. The surgeons and emergency doctors can then decide whether the child is at high risk of appendicitis and needs to be admitted, or at low risk and can be sent home. Within two years, the hospital cut its rate of CT scans on children with abdominal pain to 10%, with no increase in complications.

One of the hardest things to do in this work is to align financial incentives, said Lalit Bajaj, an emergency physician at Childrens Colorado who championed the effort, because in our health care system, we get paid for what we do.

Cutting CT scans meant less revenue. But Childrens Colorado worked with an insurance plan to create an incentive program. If the hospital could hold down the rate of high-cost imaging, saving the health plan money, it could earn a bonus from the insurer at the end of the year that would partly offset the lost revenue.

But Bajaj said its tough for doctors to deal with patient expectations for testing or treatment. Its not a great feeling for a parent to come in and I tell them how to support their child through the illness, Bajaj said. They dont really feel like they got testing done. Did they really evaluate my child? More from the Mountain States

That was a major hurdle in treating kids with bronchiolitis. That respiratory condition, most often caused by a virus, sends thousands of kids every winter to the ER at Childrens, where unneeded chest X-rays were often ordered.

The data was telling us that they really didnt provide any change in care, Bajaj said. What they did was add unnecessary expense.

Too often, doctors reading the X-rays mistakenly thought they saw a bacterial infection and prescribed antibiotics. They would also prescribe bronchodilators, like albuterol, they thought would help the kids breathe easier. But studies have shown those medicines dont relieve bronchiolitis.

Bajaj and his colleagues implemented new protocols in 2015 to educate parents on the condition, how to manage symptoms until kids get better, and why imaging or medication is unlikely to help.

These are hard concepts for folks, Bajaj said. Parents want to feel their child has been fully evaluated when they come to the ER, especially since they are often footing more of the bill.

The hospital reduced its X-ray rate from 40% in the 17 months before the new protocols to 29% in the 17 months after implementation, according to Bajaj. The use of bronchodilators dropped from 36% to 22%.

Part of the secret of Childrens success is that they brand their interventions. The hospitals quality improvement team gathers staff members from various disciplines to brainstorm ways to reduce low-value care and assign a catchy slogan to the effort: Image gently for appendicitis or Rest is best for bronchiolitis.

And then we get T-shirts made. We get mouse pads and water bottles made, Bajaj said. People really do enjoy T-shirts.

In California, the Los Angeles County Department of Health Services, one of the largest safety-net health systems in the country, typically receives a fixed dollar amount for each person it covers regardless of how many services it provides. But the staff found that 90% of patients undergoing cataract surgery were getting extensive preoperative testing, a low-value service. In other health systems, that would normally reflect a do-more-to-get-paid-more scenario.

That wasnt the case here in LA County. Doctors didnt make more money, said John Mafi, an associate professor of medicine at UCLA. It suggests that theres many other factors other than finances that can be in play.

As quality improvement staffers at the county health system looked into the reasons, they found the system had instituted a protocol requiring an X-ray, electrocardiograms, and a full set of laboratory tests before the surgery. A records review showed those extra tests werent identifying problems that would interfere with an operation, but they did often lead to unnecessary follow-up visits. An anomaly on an EKG might lead to a referral to a cardiologist, and since there was often a backlog of patients waiting for cardiology visits, the surgery could be delayed for months.

In response, the health system developed new guidelines for preoperative screenings and relied on a nurse trained in quality improvement to advise surgeons when preoperative testing was warranted. The initiative drove down the rates of chest X-rays, EKGs, and lab tests by two-thirds, with no increase in adverse events.

The initiative lot money in its first year because of high startup costs. But over three years, it resulted in modest savings of about $60,000.

A fee-for-service-driven health system where they make more money if they order more tests, they would have lost money, Mafi said, because they make a profit on each test.

Even though the savings were minimal, patients got needed surgeries faster and did not face a further cascade of unnecessary testing and treatment.

Fendrick said some hospitals make more money providing all those tests in preparation for cataract surgery than they do from the surgeries themselves.

These are older people. They get EKGs, they get chest X-rays, and they get bloodwork, he said. Some people need those things, but many dont.

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk Related Topics Health Care Reform Health Industry Insurance States Colorado Doctors Hospitals Contact Us Submit a Story Tip

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Red Sox 1B Casas out for year after knee surgery

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Red Sox 1B Casas out for year after knee surgery

BOSTON — Boston Red Sox first baseman Triston Casas suffered a ruptured tendon in his left knee and is out for the remainder of the season, the team said.

The 25-year-old Casas ruptured his patellar tendon running to first on a slow roller up the line and fell awkwardly in Boston’s victory over the Minnesota Twins on Friday night. After laying on his back in pain — not moving the knee — he was carted off on a stretcher before being taken to a Boston hospital.

The team announced Sunday that he had surgery for a left patellar tendon repair at Massachusetts General Hospital. The surgery was performed by Dr. Eric Berkson.

“I talked to him last night,” chief baseball officer Craig Breslow said in a news conference on Saturday discussing the injury outside Boston’s clubhouse. “We exchanged text messages [Saturday]. We all care deeply about just his overall wellbeing.”

Manager Alex Cora said Casas worked hard during the offseason to play every day after missing a large amount of last year with torn cartilage in his rib cage.

“He did an outstanding job in the offseason to put himself in that situation. It didn’t start the way he wanted it to,” Cora said of Casas’ struggles. “He was going to play and play a lot. Now we’ve got to focus on the rehab after the surgery and hopefully get him back stronger than ever and ready to go next year.”

Casas batted just .182 with three homers and 11 RBIs, but Breslow said his loss will be felt, especially with the team’s lack of depth at the position.

“He certainly struggled through the first month of the season but that didn’t change what we believe his production was capable of being,” Breslow said. “It’s a big loss. In addition to what we think we were going to get on the offensive side, he was kind of like a stabilizing presence on the defensive side of the field — also a big personality and a big part of the clubhouse.”

During spring training, Casas talked about how his focus at the plate this season was being more relaxed.

“You really want it until you don’t,” he said, explaining his thoughts while standing at his locker. “Then you can’t want it that much.”

Now, he’ll have to focus on his recovery plan for next season.

Casas, a left-handed batter, was placed on the 10-day injured list Saturday with infielder/outfielder Abraham Toro selected from Triple-A Worcester.

Cora said Toro — a switch-hitter — will split time at first along with Romy Gonzalez. who bats right-handed.

Breslow said the team might be exploring a long-term replacement.

“This is unfortunately an opportunity to explore what’s available,” he said. “We’ll look both internally and outside as well.”

Cora said there are no plans to move Rafael Devers, who was replaced at third by offseason free-agent acquisition Alex Bregman and moved to DH.

“We asked him to do something in spring training that in the beginning he didn’t agree with it and now he’s very comfortable doing what he’s doing,” Cora said. “Like I told you guys in spring training, he’s my DH.”

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Police foil bomb plot targeting Lady Gaga’s biggest-ever show on Copacabana beach

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Police foil bomb plot targeting Lady Gaga's biggest-ever show on Copacabana beach

Brazilian police say they foiled a bomb attack planned for a Lady Gaga concert on Rio de Janeiro’s Copacabana beach that attracted an estimated 2.1 million people.

The plot was orchestrated by a group promoting hate speech and the radicalisation of teenagers, including self-harm and violent content as a form of social belonging, according to the Civil Police of Rio de Janeiro, which worked in coordination with the country’s justice ministry.

“The suspects were recruiting participants, including minors, to carry out coordinated attacks using improvised explosives and Molotov cocktails,” the force said.

The justice ministry said the recruiters identified themselves as Gaga’s fans, known as “Little Monsters”.

It said Operation Fake Monster was based on a report by the ministry’s cyber operations lab following a tip-off from Rio state police intelligence, which uncovered digital cells encouraging violent behaviour among teenagers using coded language and extremist symbolism.

Authorities carried out over a dozen search and seizure warrants, and a man described as the group’s leader was arrested in the southern state of Rio Grande do Sul for illegal possession of a firearm, and a teenager was detained in Rio de Janeiro for storing child abuse images.

Lady Gaga performing at the huge open-air concert. Pic: Reuters
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Lady Gaga performing at the huge open-air concert. Pic: Reuters

Gaga’s biggest ever show

Some 500,000 tourists travelled to watch the concert, which was paid for by the city in an attempt to boost the struggling economy.

Saturday night’s two-hour show, which marked Gaga’s biggest ever, marked the first time she had played in Brazil since 2012, having cancelled an appearance at the Rock in Rio festival in 2017 over health issues.

Gaga, who released her seventh studio album, Mayhem, in March, opened with a dramatic, operatic edition of her 2011 track Bloody Mary, before launching into Abracadabra, a recent track.

Lady Gaga performs during her free concert on Copacabana Beach in Rio de Janeiro, Saturday, May 3, 2025. (AP Photo/Silvia Izquierdo)
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Pic: AP

Lady Gaga, centre, performs during her free concert on Copacabana Beach in Rio de Janeiro, Saturday, May 3, 2025. (AP Photo/Silvia Izquierdo)
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Pic: AP

“Brazil! I missed you. I missed you so much,” she exclaimed, before launching into Poker Face, one of her biggest hits.

The American pop star drew in a similar crowd to Madonna’s in May last year, who performed at the same beach, which is transformed into an enormous dance floor for the shows.

Addressing the crowd in English and through a Portuguese translator, Gaga became emotional as she said: “I’m so honoured to be here with you tonight.

People attend Lady Gaga's open concert at Copacabana beach in Rio de Janeiro, Brazil, May 3, 2025. REUTERS/Tita Barros
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Gaga addresses the crowd. Pic: Reuters

Gaga seen performing on giant screens set up across the beach. Pic: Reuters
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Gaga seen performing on giant screens set up across the beach. Pic: Reuters

“Tonight we’re making history, but no one makes history alone. Without all of you, the incredible people of Brazil, I wouldn’t have this moment. Thank you for making history with me.

“The people of Brazil are the reason I get to shine today. But of all the things I can thank you for, the one I most am grateful for is this: that you waited for me. You waited more than 10 years for me.”

She said it took so long to come back because she was “healing” and “getting stronger”. The pop sensation cancelled many of her shows in 2017 and 2018 due to her fibromyalgia condition, which can cause pain and fatigue.

It is estimated Gaga’s show will have injected around 600 million reais (£79.9m) into the economy, nearly 30% more than Madonna’s show.

People gather to attend Lady Gaga's open concert, in Copacabana beach in Rio de Janeiro, Brazil May 3, 2025. REUTERS/Pilar Olivares
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Pic: Reuters

Read more:
John Lithgow on JK Rowling’s trans stance backlash
Why are the band Kneecap controversial?

The large-scale free shows are set to continue annually until at least 2028, always taking place in May, which is considered the economy’s “low season”, according to the city’s government.

A hefty security plan was in place, including the presence of 3,300 military and 1,500 police officers, along with 400 military firefighters.

‘A dream come true’

Fans find a spot to watch the show. Pic: AP
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Pic: AP

The city has been swarmed with Gaga fans since her arrival on Tuesday, with some even keeping vigil outside of the hotel she has been staying at.

Many arrived at the beach at the crack of dawn on Saturday to secure good spots on the beach, despite the show not starting until 9.45pm.

An aerial view shows fans gathering on Copacabana beach ahead of Lady Gaga's arrival. Pic: Reuters
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An aerial view shows fans gathering on Copacabana beach ahead of Lady Gaga’s arrival. Pic: Reuters

Ana Lara Folador, who attended with her sister, said it was “a dream come true”, and that Gaga had “really shaped a part of my personality, as a person and an artist”.

Ingrid Serrano, a 30-year-old engineer who made a cross-continent trip from Colombia to Brazil to attend the show, turned up in a T-shirt featuring Lady Gaga’s outlandish costumes over the years.

“I’ve been a 100% fan of Lady Gaga my whole life,” she said, adding the 39-year-old megastar represented “total freedom of expression – being who one wants without shame”.

A fan dons an unusual face mask. Pic: AP
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A fan dons an unusual face mask. Pic: AP

A fan strikes a pose. Pic: AP
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A fan strikes a pose. Pic: AP

Matheus Silvestroni, 25, an aspiring DJ and a Gaga fan since the age of 12, endured an eight-hour bus ride from Sao Paulo for the show.

He said it was Gaga who had inspired him to embrace his sexuality and pursue his dream of becoming an artist.

“I was bullied because I was a fat, gay kid, so I was an easy target,” he said. “Gaga was very important because she sent a message that everything was okay with me, I wasn’t a freak, because I was ‘Born This Way’.”

Rio is known for holding massive open-air concerts, with Rod Stewart holding a Guinness World Record for the four million-strong crowd he drew to Copacabana beach in 1994.

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John Lithgow on JK Rowling’s trans stance backlash: ‘She’s handled it fairly gracefully’

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John Lithgow on JK Rowling's trans stance backlash: 'She's handled it fairly gracefully'

John Lithgow is a man well aware of cancel culture and its ability to destroy careers in the blink of an eye.

The Oscar-nominated actor tells Sky News: “It is terrible to be so careful about what you say. Even in an interview like this. It goes into the world, and you can get misconstrued and misrepresented and cancelled in [the click of a finger].”

Pic: Johan Persson
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Roald Dahl is the subject of West End play Giant, by Mark Rosenblatt. Pic: Johan Persson

It’s a theme that runs parallel with his latest work – the stage show Giant – which through the lens of one explosive day in children’s author Roald Dahl‘s life, poses the question, should we look for moral purity in our artists?

The writer of great works including The Witches, Matilda and The BFG, Dahl revolutionised children’s literature with his irreverent approach, inspiring generations of readers and selling hundreds of millions worldwide. But his legacy is conflicted.

Lithgow describes Dahl as “a man with great charm, great wit and literary talent. A man who really cared about children and loved them. But a man who carried a lot of demons.”

Specifically, the play – which explores Palestinian rights versus antisemitism – deals with the fallout from controversial comments the children’s author made over the Israeli invasion of Lebanon in 1982. Its themes couldn’t be more timely.

Lithgow explains: “Things are said in the play that nobody dares to say out loud… But God knows this is a complicated and contradictory issue.”

More on Jk Rowling

Pic: Johan Persson
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John Lithgow plays Dahl – a man capable of ‘great compassion’ and ‘enormous cruelty’. Pic: Johan Persson

‘It didn’t start as an idea about Roald Dahl at all’

So controversial are some of the play’s themes, the 79-year-old star admits his own son warned him: “Prepare yourself. There’ll be demonstrations in Sloane Square outside the Royal Court Theatre.”

Indeed, the play’s first run carried an audience warning flagging “antisemitic language; graphic descriptions of violence; emotional discussion of themes including conflict in the Middle East, Israel and Palestine; and strong language”.

But it didn’t put audiences off. Following a sold-out run at the Royal Court, the role won Lithgow an Olivier. Now, it’s transferring to London’s West End.

The play was written by Mark Rosenblatt, a seasoned theatre director but debut playwright.

He tells Sky News: “It didn’t start as an idea about Roald Dahl at all. It was about the blurring of meaningful political discourse with racism, specifically when, in 2018, the inquiry into antisemitism in the Labour Party started to come out.”

Rosenblatt describes Dahl’s Revolting Rhymes and Dirty Beasts as the “wallpaper” of his childhood, and says he had no desire to “smash the Roald Dahl pinata”.

But despite the fond recollections, he was conflicted: “Understanding that [Dahl] also, possibly, didn’t like someone like me because I’m Jewish felt complicated.” It was Rosenblatt’s exploration of “how you hold those two things at the same time” that led to Dahl becoming the play’s focus.

Elliot Levey plays Dahl's Jewish publisher, and Aya Cash plays an American Jewish sales executive. Pic: Johan Persson
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Elliot Levey plays Dahl’s Jewish publisher, and Aya Cash plays an American Jewish sales executive. Pic: Johan Persson

‘He’s not cancelled in our home’

Rosenblatt describes him as “a complex man, capable of great compassion, great passionate defence of oppressed people, and also capable of enormous cruelty and manipulation. He was many things at once”.

And as for Dahl’s place in his life now? Rosenblatt says: “I still read his books to my kids. He’s certainly not cancelled in our home.”

It’s likely that Dahl’s comments, if uttered today, would lead to swift social media condemnation, but writing in a pre-social media age, the judgment over his words came at a much slower pace.

Dahl died in 1990, and his family later apologised for antisemitic remarks he made during his lifetime. But the debate of whether art can be separated from the artist is still very much alive today.

Earlier this month, Lithgow found himself drawn into a different row over artists and their opinions – this time concerning author JK Rowling.

Author and Lumos Foundation founder J.K. Rowling attends the HBO Documentary Films premiere of ...Finding the Way Home" at 30 Hudson Yards on Wednesday, Dec. 11, 2019, in New York. (Photo by Evan Agostini/Invision/AP)
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JK Rowling in 2019. Pic:AP

‘A matter of nuance’

Soon to play Dumbledore in the Harry Potter TV series, he has been criticised by some fans for working with the author known for her gender critical beliefs.

Lithgow told Sky News: “It’s a question I’m getting asked constantly. I suppose I should get used to that, but JK Rowling has created an amazing canon of books for kids…

“I have my own feelings on this subject. But I’m certainly not going to hesitate to speak about it. Just because I may disagree… It’s a matter of nuance… I think she’s handled it fairly gracefully.”

The actor ignored calls not to take the role.

He goes on: “Honestly, I’d rather be involved in this than not. And if I’m going to speak on this subject, I’m speaking from inside this project and very much a partner with JK Rowling on it.”

Demanding an eight-year commitment and a move to the UK for the part, the stakes are high.

And with a legion of Harry Potter fans watching on from the wings, only time will tell if the Lithgow-Rowling partnership will prove a magical one.

Giant is playing at the Harold Pinter Theatre in London until Saturday, 2 August.

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