The personnel and equipment costs associated with performing complex medical procedures are extraordinary. For example to perform complex spine surgery to repair a fracture ideally the surgeon requires a Jackson operating table (140k) and intraoperative 3D visualization systems such as an O-arm (900k). Such equipment and personnel should be localized to regional centers to which appropriately complex patients should then be referred.
As an example, one VA hospital in each region should have an intraoperative neuronavigation system for brain imaging (400k). All VA patients with brain tumors within a reasonable distance should then be referred to that center.
What currently occurs is that hospitals with low volumes of complex procedures often rent equipment for complex cases, or buy it and use it infrequently. Reviews of surgical outcomes have demonstrated that centers performing higher volumes of any given procedure tend to have better outcomes, so this cost-saving measure would also improve patient care.