1
|
Ball DD, Sadler AG, Steffen MJ, Paez MB, Mengeling MA. The impact of patient-provider relationships on choosing between VA and VA-purchased care: A qualitative study of health care decision-making among rural veterans. J Rural Health 2024; 40:430-437. [PMID: 37942663 DOI: 10.1111/jrh.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Since the Choice Act in 2014, many Veterans have had greater options for seeking Veteran Affairs (VA)-purchased care in the community. We investigated factors that influence rural Veterans' decisions regarding where to seek care. METHODS We utilized semi-structured telephone interviews to query Veterans living in rural or highly rural areas of Midwestern states about their health care options, preferences, and experiences. Interviews were recorded and transcribed, thematically coded, and deductively analyzed using a socioecological approach. FINDINGS Forty rural Veterans (20 men/20 women) ages 28-76 years completed interviews in 2019. We found that rural Veterans often spoke about their relationships and interactions with providers as an important factor in deciding where to seek care. They expressed three socioecological qualities of patient-provider relationships that affected their decisions: (1) personal level-rural Veterans traveled longer distances for more compatible patient-provider relationships; (2) interpersonal level-they sought stable patient-provider relationships that encouraged familiarity, trust, and communication; and (3) organizational level-they emphasized shared identities and expertise that fostered a sense of belonging with their provider. Participants also described how impersonal interactions, status differences, and staff turnover impacted their choice of provider and were disruptive to patient-provider relationships. CONCLUSIONS Rural Veterans' interview responses suggest exploring innovative ways to measure socioecological dimensions (i.e., personal, interpersonal, and organizational) of access-related decisions and patient-provider relationships to better understand health care barriers and needs. Such measures align with the VA's Whole Health approach that emphasizes person-centered care and the value of social relationships to Veterans' health.
Collapse
Affiliation(s)
- Daniel D Ball
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Anne G Sadler
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Melissa J Steffen
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Monica B Paez
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Michelle A Mengeling
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| |
Collapse
|
2
|
Eck CS, Ho V, Jiang C, Petersen LA. Determinants of referral network size for screening colonoscopies in the Veterans Health Administration after the implementation of the MISSION Act. Health Serv Res 2024; 59:e14239. [PMID: 37750017 PMCID: PMC10771900 DOI: 10.1111/1475-6773.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To measure key characteristics of the Veterans Health Administration's (VHA) Community Care (CC) referral network for screening colonoscopy and identify market and institutional factors associated with network size. DATA SOURCES VHA electronic health records, CC claim data, and National Plan and Provider Enumeration System. STUDY DESIGN In this retrospective cross-sectional study, we measure the size of the VHA's CC referral networks over time and by VHA parent facility (n = 137). We used a multivariable linear regression to identify factors associated with network size at the market-year level. Network size was measured as the number of physicians who performed at least one VHA-purchased screening colonoscopy per 1000 enrollees at baseline. DATA EXTRACTION Data were extracted for all Veterans (n = 102,119) who underwent a screening colonoscopy purchased by the VHA from a non-VHA physician from 2018 to 2021. PRINCIPAL FINDINGS From 2018 to 2021, median network volume of screening colonoscopies per 1000 enrollees grew from 1.6 (IQR: 0.6, 4.6) to 3.6 (IQR: 1.6, 6.6). The median network size grew from 0.63 (IQR: 0.30, 1.26) to 0.92 (IQR: 0.57, 1.63). Finally, the median procedures per physician increased from 2.5 (IQR: 1.6, 4.2) to 3.2 (IQR: 2.4, 4.7). After adjusting for baseline market characteristics, volume of screening colonoscopies was positively related to network size (β = 0.15, 95% CI: [0.10, 0.20]), negatively related to procedures per physician (β = -0.12, 95% CI: [-0.18, -0.05]), and positively associated with the percent of rural enrollees (β = 0.01, 95% CI: [0.00, 0.01]). CONCLUSIONS VHA facilities with a higher volume of VHA-purchased screening colonoscopies and more rural enrollees had more non-VHA physicians providing care. Geographic variation in referral networks may also explain differences in the effects of the MISSION Act on access to care and patient outcomes.
Collapse
Affiliation(s)
- Chase S. Eck
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)HoustonTexasUSA
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Vivian Ho
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
- Department of EconomicsRice UniversityHoustonTexasUSA
- Baker Institute for Public PolicyRice UniversityHoustonTexasUSA
| | - Cheng Jiang
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)HoustonTexasUSA
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Laura A. Petersen
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)HoustonTexasUSA
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| |
Collapse
|
3
|
Blegen M, Ko J, Salzman G, Begashaw MM, Ulloa JG, Girgis M, Shekelle P, Maggard-Gibbons M. Comparing Quality of Surgical Care Between the US Department of Veterans Affairs and Non-Veterans Affairs Settings: A Systematic Review. J Am Coll Surg 2023; 237:352-361. [PMID: 37154441 PMCID: PMC10344435 DOI: 10.1097/xcs.0000000000000720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
In response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 to create a program for patients to receive care in non-VA sites of care, paid by VA. Questions remain about the quality of surgical care between these sites in specific and between VA and non-VA care in general. This review synthesizes recent evidence comparing surgical care between VA and non-VA delivered care across the domains of quality and safety, access, patient experience, and comparative cost/efficiency (2015 to 2021). Eighteen studies met the inclusion criteria. Of 13 studies reporting quality and safety outcomes, 11 reported that quality and safety of VA surgical care were as good as or better than non-VA sites of care. Six studies of access did not have a preponderance of evidence favoring care in either setting. One study of patient experience reported VA care as about equal to non-VA care. All 4 studies of cost/efficiency outcomes favored non-VA care. Based on limited data, these findings suggest that expanding eligibility for veterans to get care in the community may not provide benefits in terms of increasing access to surgical procedures, will not result in better quality, and may result in worse quality of care, but may reduce inpatient length of stay and perhaps cost less.
Collapse
Affiliation(s)
- Mariah Blegen
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
- National Clinician Scholars Program (Blegen, Salzman) University of California–Los Angeles, Los Angeles, CA
- Department of Surgery, David Geffen School of Medicine (Blegen, Ko, Salzman, Ulloa, Girgis, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Jamie Ko
- Department of Surgery, David Geffen School of Medicine (Blegen, Ko, Salzman, Ulloa, Girgis, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Garrett Salzman
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
- National Clinician Scholars Program (Blegen, Salzman) University of California–Los Angeles, Los Angeles, CA
- Department of Surgery, David Geffen School of Medicine (Blegen, Ko, Salzman, Ulloa, Girgis, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Meron M Begashaw
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Jesus G Ulloa
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
- Department of Surgery, David Geffen School of Medicine (Blegen, Ko, Salzman, Ulloa, Girgis, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Mark Girgis
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
- Department of Surgery, David Geffen School of Medicine (Blegen, Ko, Salzman, Ulloa, Girgis, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Paul Shekelle
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
| | - Melinda Maggard-Gibbons
- From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
- Department of Surgery, David Geffen School of Medicine (Blegen, Ko, Salzman, Ulloa, Girgis, Maggard-Gibbons) University of California–Los Angeles, Los Angeles, CA
- Olive View—University of California–Los Angeles Medical Center, Sylmar, CA (Maggard-Gibbons)
| |
Collapse
|
4
|
Palani S, Garrido MM, Tenso K, Pizer SD. Community care emergency room use and specialty care leakage from Veterans Health Administration hospitals. Acad Emerg Med 2023; 30:379-387. [PMID: 36660799 DOI: 10.1111/acem.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Care leakage from health systems can affect quality and cost of health care delivery. Identifying modifiable predictors of care leakage may help health systems avoid adverse consequences. Out-of-system emergency department (ED) use may be one modifiable cause of care leakage. Our objective was to investigate the relationship between out-of-system ED use and subsequent specialty care leakage. METHODS We used the Veterans Health Administration's (VA) Corporate Data Warehouse data from January 2021 to July 2021. A total of 330,547 patients who had at least one ED visit (in-house or community care [CC]) in the index period (January 2021-March 2021) were included. Outcomes were the proportions of specialty care visits in the community within 30, 60, 90, and 120 days from the index ED visit. Instrumental-variables regressions, using VA ED physician capacity as an instrument for Veterans' CC ED use, were utilized to estimate the proportions of subsequent specialty care visits in the community. Estimates were adjusted for patient and facility characteristics. RESULTS A CC ED visit was associated with increases in the proportions of specialty care visits in the community within 30, 60, 90, and 120 days from index visit. Within 30 days from index visit, CC ED patients were estimated to have a 45-percentage-point (pp; 95% confidence interval [CI], 43-47 pp) higher proportion of CC specialty care visits than patients with an in-house ED visit (p < 0.001). We observed similar, though slightly attenuated, results over long time periods since the index visit. CONCLUSIONS Veterans who have a CC ED visit have a greater proportion of subsequent specialty care visits in CC hospitals and clinics than Veterans with a VA ED visit. This relationship persists when we examine Veterans whose decision to go to a CC ED is influenced by VA ED physician capacity rather than general preferences for CC.
Collapse
Affiliation(s)
- Sivagaminathan Palani
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Melissa M Garrido
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kertu Tenso
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Steven D Pizer
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Meer EA, Oh DH, Brodie FL. Time and Distance Cost of Longer Acting Anti-VEGF Therapies for Macular Degeneration: Contributions to Drug Cost Comparisons. Clin Ophthalmol 2022; 16:4273-4279. [PMID: 36578665 PMCID: PMC9792116 DOI: 10.2147/opth.s384995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the holistic cost of longer acting anti-VEGF therapy for macular degeneration when considering the associated costs of travel to the retina clinic. Design Theoretical evaluation of cost using publicly available pricing data and reimbursements at the Veterans Affairs (VA) Medical Center. Patients and Methods Setting: VA Medical Center. Study population: Patients with age related macular degeneration. Main outcome measures: Three-year cost of therapy when considering medication as well as travel costs and time spent in transit. Results Based on cost data derived purely from wholesale acquisition cost and projected injection frequency over the first three years of treatment, faricimab is less expensive than ranibizumab and aflibercept by $37,709 and $6359, respectively. Aflibercept is less expensive ranibizumab by $31,350 over the first 3 years of treatment. When considering even small distances traveled by patients, these cost differences grow, amplified at even larger distances: at 25 miles, ranibizumab becomes $38,814 and $32,133 more expensive than faricimab and aflibercept, respectively. Aflibercept becomes $6681 more expensive than faricimab. At 100 miles, ranibizumab becomes $41,502 and $34,038 more expensive than faricimab and aflibercept, respectively. Aflibercept becomes $7464 more expensive than faricimab. Conclusion Longer acting anti-VEGF therapies may differ not only in their wholesale acquisition cost, but also in the frequency of per label injections and associated clinic visits. Taking into account distance and time cost of travel may contribute to a more holistic view of cost differences among these therapies.
Collapse
Affiliation(s)
- Elana A Meer
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Dennis H Oh
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Dermatology, University of California, San Francisco, CA, USA
| | - Frank L Brodie
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA,Department of Ophthalmology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Correspondence: Frank L Brodie, University of California, San Francisco, Wayne and Gladys Valley Center for Vision, 490 Illinois Street, San Francisco, CA, 94158, Email
| |
Collapse
|
6
|
Giori NJ, Beilstein-Wedel EE, Shwartz M, Harris AHS, Vanneman ME, Wagner TH, Rosen AK. Association of Quality of Care With Where Veterans Choose to Get Knee Replacement Surgery. JAMA Netw Open 2022; 5:e2233259. [PMID: 36178687 PMCID: PMC9526089 DOI: 10.1001/jamanetworkopen.2022.33259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Recent legislation expanded veterans' access to Veterans Health Administration (VA)-purchased care. Quality should be considered when choosing where to get total knee arthroplasty (TKA), but currently available quality metrics provide little guidance. Objective To determine whether an association exists between the proportion of TKAs performed (vs purchased) at each VA facility and the quality of care provided (as measured by short-term complication rates). Design, Setting, and Participants This 3-year cohort study used VA and community care data (fiscal year 2017 to fiscal year 2019) from the VA's Corporate Data Warehouse. Complications were defined following the Centers for Medicare and Medicaid Services' methodology. The setting included 140 VA health care facilities performing or purchasing TKAs. Participants included veterans who had 43 371 primary TKA procedures that were either VA-performed or VA-purchased during the study period. Exposures Of the 43 371 primary TKA procedures, 18 964 (43.7%) were VA-purchased. Main Outcomes and Measures The primary outcome was risk-standardized short-term complication rates of VA-performed or VA-purchased TKAs. The association between the proportion of TKAs performed at each VA facility and quality of VA-performed and VA-purchased care was examined using a regression model. Subgroups were also identified for facilities that had complication rates above or below the overall mean complication rate and for facilities that performed more or less than half of the facility's TKAs. Results Among the study sample's 41 775 veterans who underwent 43 371 TKAs, 38 725 (89.3%) were male, 6406 (14.8%) were Black, 33 211 (76.6%) were White, and 1367 (3.2%) had other race or ethnicity (including American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander); mean (SD) age was 66.9 (8.5) years. VA-performed and VA-purchased TKAs had a mean (SD) raw overall short-term complication rate of 2.97% (0.08%). There was no association between the proportion of TKAs performed in VA facilities and risk-standardized complication rates for VA-performed TKAs, and no association for VA-purchased TKAs. Conclusions and Relevance In this cohort study, surgical quality did not have an association with where veterans had TKA, possibly because meaningful comparative data are lacking. Reporting local and community risk-standardized complication rates may inform veterans' decisions and improve care. Combining these data with the proportion of TKAs performed at each site could facilitate administrative decisions on where resources should be allocated to improve care.
Collapse
Affiliation(s)
- Nicholas J. Giori
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
| | - Erin E. Beilstein-Wedel
- Center for Health Care Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts
| | - Michael Shwartz
- Center for Health Care Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts
| | - Alex H. S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford University, Stanford, California
| | - Megan E. Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Todd H. Wagner
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Amy K. Rosen
- Center for Health Care Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
7
|
Wagner TH, Lo J, Beilstein-Wedel E, Vanneman ME, Shwartz M, Rosen AK. Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration. MDM Policy Pract 2021; 6:23814683211057902. [PMID: 34820527 PMCID: PMC8606928 DOI: 10.1177/23814683211057902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background. Veterans' access to Veterans Affairs (VA)-purchased community care expanded due to large increases in funding provided in the 2014 Veterans Choice Act. Objectives. To compare costs between VA-delivered care and VA payments for purchased care for two commonly performed surgeries: total knee arthroplasties (TKAs) and cataract surgeries. Research Design. Descriptive statistics and regressions examining costs in VA-delivered and VA-purchased care (fiscal year [FY] 2018 [October 2017 to September 2018]). Subjects. A total of 13,718 TKAs, of which 6,293 (46%) were performed in VA. A total of 91,659 cataract surgeries, of which 65,799 (72%) were performed in VA. Measures. Costs of VA-delivered care based on activity-based cost estimates; costs of VA-purchased care based on approved and paid claims. Results. Ninety-eight percent of VA-delivered TKAs occurred in inpatient hospitals, with an average cost of $28,969 (SD $10,778). The majority (86%) of VA-purchased TKAs were also performed at inpatient hospitals, with an average payment of $13,339 (SD $23,698). VA-delivered cataract surgeries were performed at hospitals as outpatient procedures, with an average cost of $4,301 (SD $2,835). VA-purchased cataract surgeries performed at hospitals averaged $1,585 (SD $629); those performed at ambulatory surgical centers cost an average of $1,346 (SD $463). We also found significantly higher Nosos risk scores for patients who used VA-delivered versus VA-purchased care. Conclusions. Costs of VA-delivered care were higher than payments for VA-purchased care, but this partly reflects legislative caps limiting VA payments to community providers to Medicare amounts. Higher patient risk scores in the VA could indicate that community providers are reluctant to accept high-risk patients because of Medicare reimbursements, or that VA providers prefer to keep the more complex patients in VA.
Collapse
Affiliation(s)
- Todd H. Wagner
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
- Department of Surgery, Stanford University, Stanford, California
| | - Jeanie Lo
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
| | - Erin Beilstein-Wedel
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Megan E. Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael Shwartz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Amy K. Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|