Trends in the Purchase of Surgical Care in the Community by the Veterans Health Administration
- 1 July 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Medical Care
- Vol. 55 (Suppl 1), S45-S52
- https://doi.org/10.1097/mlr.0000000000000707
Abstract
Background: The 2014 implementation of the Veterans Choice Program increased opportunities for Veterans to receive care in the community. Although surgical care is a Veterans Health Administration (VHA) priority, little is known about the types of surgeries provided in the VHA versus those referred to community care (CC), and whether Veterans are increasing their use of surgical care through CC with these additional opportunities. Objectives: To examine national trends across VHA facilities in the frequencies and types of surgeries provided in the VHA and through CC, and explore the association between facilities’ purchase of care with rurality and surgical complexity designation. Research Design: Retrospective study using Veterans Administration (VA) outpatient and CC data from the VA’s Corporate Data Warehouse (October 1, 2013–September 30, 2016). Measures: Veterans’ demographics, outpatient surgeries, facility rurality, and surgical complexity. Results: Our sample included 525,283 outpatient surgeries; 79% occurred in the VHA over the study timeframe. The proportion of CC surgeries increased from 16% in October 2013 to 29% in December 2014, and then subsequently declined, leveling off at 21% in June 2016 (trend, PPP<0.0001). Conclusions: Although the VHA remains the primary provider of surgical care for Veterans, Veterans Choice Program implementation increased Veterans’ use of CC relative to the VHA for certain types of surgeries, potentially bringing challenges to the VHA in delivering and coordinating surgical care across settings.Keywords
This publication has 10 references indexed in Scilit:
- Dual Health Care System Use and High-Risk Prescribing in Patients With DementiaAnnals of Internal Medicine, 2016
- Association Between Postoperative Admission and Location of Hernia SurgeryJAMA Surgery, 2016
- Beyond the VA Crisis — Becoming a High-Performance NetworkNew England Journal of Medicine, 2016
- Dual‐System Use and Intermediate Health Outcomes among Veterans Enrolled in Medicare Advantage PlansHealth Services Research, 2015
- Comparison of Complication Rates in Veterans Receiving Cataract Surgery Through the Veterans Health Administration and MedicareMedical Care, 2012
- Factors Associated with Program Utilization of Radiation Therapy Treatment for VHA and Medicare Dually Enrolled PatientsJournal of Community Health, 2011
- Fifteen years of the National Surgical Quality Improvement Program in reviewThe American Journal of Surgery, 2009
- Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National SampleAnnals of Internal Medicine, 2004
- Perceptions of Care of Patients Undergoing Coronary Artery Bypass Surgery in Veterans Health Administration and Private Sector HospitalsAmerican Journal of Medical Quality, 2003
- In-Hospital Mortality Following Coronary Artery Bypass Graft Surgery in Veterans Health Administration and Private Sector HospitalsMedical Care, 2003