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BACKGROUND/RATIONALE:
Elderly and disabled veterans who use VA outpatient services and have FFS Medicare Part B coverage that pays for outpatient services have at least two potential sources for primary care the Veteran Affairs (VA) health care system and non-VA outpatient facilities reimbursed by Medicare. According to a comprehensive analysis of VA and Medicare use by all VA users conducted by the VA Management Science Group, the number of dual users of VA and Medicare services grew 20% between 1998-2000 from 1.6 million veterans to 2.0 million veterans. Access to multiple sources of primary care creates the possibility that veterans will obtain care from multiple sources simultaneously, referred to as dual use. Dual use may adversely affect continuity of care or lead to unnecessary duplication of outpatient services.
OBJECTIVE(S):
This study will address three primary research questions related to dual use, continuity of care and service duplication:
1. What proportion of veterans use both VA and FFS Medicare for primary care, what are the characteristics of veterans who use both systems, and what are the determinants of dual use?
a. What are the VA and Medicare utilization patterns of VA primary care users? What proportion of dual use is predominantly to receive medications from the VA?
b. Is the proportion of dual users different between patients who obtain primary care at CBOCs and VAMC primary care clinics?
2. Is the continuity of care of dual users different from veterans who only obtain VA primary care?
a. Does continuity of care of dual users differ for CBOC and VAMC patients?
3. Do veterans who use both VA and FFS Medicare primary care and receive an outpatient service from a VA provider also receive the same service from a FFS Medicare provider? If so, what specific types of services are duplicated?
METHODS:
This project will be a longitudinal cohort study, based on the study sample created for a current CBOC cost evaluation project (Maciejewski-PI). We will add patient-level data for FY2002-2004 from the Outpatient Care File, Patient Treatment File, and DSS Inpatient and Outpatient National Extracts at the VA Austin Automation Center to the 2000-2001 data extracted for the current study. We will obtain Medicare data for the study sample for fiscal years 2000-2004 from the VA Information Resource Center (VIReC). The study sample will include VA primary care users with Medicare Part A and Part B coverage between 2000-2004. Analyses of dual use and continuity of care will use the entire sample, while duplication of services will focus only on dual users.
The dependent variables discussed above will be analyzed in bivariate comparisons and time trend analyses, in addition to multivariate regressions appropriate to the distributions of each dependent variable. All analyses will be conducted using STATA.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Dual use has significant impacts on allocating resources in the VA system. Examination of dual use by CBOC and VAMC patients will enable correct specification of capitated payments to contract CBOCs. To project how proposed policy changes may induce changes in the types of VA users seeking VA outpatient care, it is necessary to understand what factors motivate VA users to dually use Medicare outpatient services. If continuity of care is adversely affected by dual use then the VA may need to find ways to coordinate care with non-VA providers, especially for those patients who use the VA only for medications. If a veteran receives duplicated high cost or high frequency outpatient procedures (e.g., MRI or PSA) or preventive care (e.g., dilated eye exam for veterans with diabetes) in both systems, then this dual use represents an opportunity for coordination to increase efficiency and reduce overall health care costs.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
none
Keywords:
VA/non-VA comparisons
MeSH Terms:
none
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