Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration

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 kn...

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Autores principales:	Todd H. Wagner, Jeanie Lo, Erin Beilstein-Wedel, Megan E. Vanneman, Michael Shwartz, Amy K. Rosen
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/257614c93ffd415cba950fb61f9eaa41
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spelling	oai:doaj.org-article:257614c93ffd415cba950fb61f9eaa412021-11-17T22:33:19ZEstimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration2381-468310.1177/23814683211057902https://doaj.org/article/257614c93ffd415cba950fb61f9eaa412021-11-01T00:00:00Zhttps://doi.org/10.1177/23814683211057902https://doaj.org/toc/2381-4683Background. 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.Todd H. WagnerJeanie LoErin Beilstein-WedelMegan E. VannemanMichael ShwartzAmy K. RosenSAGE PublishingarticleMedicine (General)R5-920ENMDM Policy & Practice, Vol 6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Todd H. Wagner Jeanie Lo Erin Beilstein-Wedel Megan E. Vanneman Michael Shwartz Amy K. Rosen Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration
description	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.
format	article
author	Todd H. Wagner Jeanie Lo Erin Beilstein-Wedel Megan E. Vanneman Michael Shwartz Amy K. Rosen
author_facet	Todd H. Wagner Jeanie Lo Erin Beilstein-Wedel Megan E. Vanneman Michael Shwartz Amy K. Rosen
author_sort	Todd H. Wagner
title	Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration
title_short	Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration
title_full	Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration
title_fullStr	Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration
title_full_unstemmed	Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration
title_sort	estimating the cost of surgical care purchased in the community by the veterans health administration
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/257614c93ffd415cba950fb61f9eaa41
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Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration

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