Comparing the characteristics, utilization, efficiency, and outcomes of VA and non-VA inpatient care provided to VA enrollees: a case study in New York.
ABSTRACT To compare the characteristics, utilization, and outcomes of Veterans Health Administration (VA) and non-VA inpatient care provided to VA enrollees in New York.
Using VA and New York State administrative and clinical databases, we conducted a retrospective study examining 110,716 residents of New York State who were enrolled in the VA and had 266,869 inpatient admissions in VA and non-VA hospitals in New York. For each admission, we determined the system of care used (VA or non-VA), patient demographics, and characteristics of the admission, and we calculated VA patients' relative reliance on the VA for inpatient care. For each Major Diagnostic Category (MDC), we examined reliance, patient characteristics, and lengths-of-stay for 2 groups: veterans who were younger than age 65 and those age 65 or older.
Fifty-three percent of younger patients' inpatient admissions were in the VA, whereas 32% of older patients' were; however, relative reliance on the VA varied dramatically across the 19 MDCs examined. Across age groups, patients admitted to VA hospitals were younger, less likely to be white, and less likely to live in a rural setting. Those using VA hospitals had lower Charlson scores and received less complex care. For both age groups and across all MDCs, admissions to VA hospitals had substantially higher diagnosis related group-specific observed-to-expected lengths-of-stay.
Younger and older veterans use VA and non-VA hospitals differently for inpatient services. Comprehensive inpatient datasets could inform planners about VA's service market and VA managers about achievable performance benchmarks that are relevant to VA's service population.
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ABSTRACT: To determine, for Veterans Health Administration (VA) enrollees who lived and were hospitalized in New York State between 1998 and 2000, the primary payers for their non-VA admissions, whether the primary payer mix varied by condition treated, and whether the Medicare claims data that VA acquired on its Medicare-enrolled patients captured all or most of their non-VA inpatient care. Using VA and New York State administrative and clinical databases, we conducted a retrospective study examining 75,046 residents of New York State who were enrolled in the VA and had 159,843 inpatient admissions in New York hospitals not in the VA system. For each admission, we determined the major diagnostic category, the primary payer for the admission, and whether the patient was Medicare-enrolled. Our analyses separated veterans into those younger than age 65 and those ages 65 or older. The payer mix for younger veterans' non-VA admissions varied considerably by major diagnostic category. Among veterans who also were Medicare enrollees, Medicare did not pay for 10% of the non-VA hospitalizations of older patients or 20% of those for younger patients. Using only Medicare claims data may significantly underestimate VA patients' reliance on non-VA inpatient care. To better inform planners about VA's service market and diagnosis-specific service utilization patterns across VA and non-VA providers, VA should work with states to develop comprehensive inpatient datasets.Medical care 09/2008; 46(8):872-7. DOI:10.1097/MLR.0b013e3181791ac0 · 3.23 Impact Factor
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ABSTRACT: We sought to determine whether the VA provides health care at a low cost. For fiscal years 2001-2007, we used data from the National Center for Health Statistics to calculate the VA's average per capita health care costs. We used data from the Medical Expenditure Panel Survey to calculate the average market value of health care received by patients who used the VA for health care. Finally, we examined several measures of health care quality provided by the VA and the private sector. Overall, VA health care costs 33 percent more than it would if purchased in the private sector (95 percent Confidence interval: 19 percent - 52 percent more); VA inpatient care costs were 56 percent higher (95 percent Confidence interval: 27 percent - 105 percent higher). The VA maintains a quality advantage in outpatient care, but its inpatient advantage has narrowed over recent years, and there is evidence that VA surgical care has worse outcomes than private sector surgical care. The VA's health care costs are considerably higher than could be purchased in the private sector. The VA should consider outsourcing inpatient services to high performance private sector hospitals.Journal of health care finance 11/2009; 35(4):1-12.
Article: Systematic Review[Show abstract] [Hide abstract]
ABSTRACT: The Veterans Health Administration, the nation's largest integrated delivery system, launched an organizational transformation in the mid 1990 s to improve the quality of its care. To synthesize the evidence comparing the quality of medical and other nonsurgical care in Veterans Affairs (VA) and non-VA settings. MEDLINE database and bibliographies of retrieved studies. Studies comparing the technical quality of nonsurgical care in VA and US non-VA settings published between 1990 and August 2009. Two physicians independently reviewed 175 unique studies identified using the search strategy and abstracted data related to 6 domains of study quality. Thirty-six studies met the inclusion criteria. All 9 general comparative studies showed greater adherence to accepted processes of care or better health outcomes in the VA compared with care delivered outside the VA. Five studies of mortality following an acute coronary event found no clear survival differences between VA and non-VA settings. Three studies of care processes after an acute myocardial infarction found greater rates of evidence-based drug therapy in VA, and 1 found lower use of clinically-appropriate angiography in the VA. Three studies of diabetes care processes demonstrated a performance advantage for the VA. Studies of hospital mortality found similar risk-adjusted mortality rates in VA and non-VA hospitals. Most studies used decade-old data, assessed self-reported service use, or included only a few VA or non-VA sites. Studies that assessed recommended processes of care almost always demonstrated that the VA performed better than non-VA comparison groups. Studies that assessed risk-adjusted mortality generally found similar rates for patients in VA and non-VA settings.Medical care 10/2010; 49(1):76-88. DOI:10.1097/MLR.0b013e3181f53575 · 3.23 Impact Factor