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Comparative Study
. 2010 Oct;45(5 Pt 1):1268-86.
doi: 10.1111/j.1475-6773.2010.01123.x.

Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics

Chuan-Fen Liu  1 , Michael Chapko, Chris L Bryson, James F Burgess Jr, John C Fortney, Mark Perkins, Nancy D Sharp, Matthew L Maciejewski
Affiliations
Comparative Study

Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics

Chuan-Fen Liu et al. Health Serv Res. 2010 Oct.

Abstract

Objective: To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients.

Data sources/study setting: VA administrative and Medicare claims data from 2001 to 2004.

Study design: Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients.

Principal findings: A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3-4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80).

Conclusions: Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care.

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Figures

Figure 1
Figure 1
Outpatient Use in Veterans Health Administration and Medicare by Visit Type, 2001–2004
Figure 2
Figure 2
Mean Number of Outpatient Visits in Medicare and Veterans Health Administration by Visit Type, 2001–2004
See this image and copyright information in PMC

References

    1. Bean-Mayberry B, Chang CC, McNeil M, Hayes P, Scholle SH. Comprehensive Care for Women Veterans: Indicators of Dual Use of VA and Non-VA Providers. Journal of the American Medical Women's Association. 2004;59(3):192–7. - PubMed
    1. Borowsky SJ, Cowper DC. Dual Use of VA and Non-VA Primary Care. Journal of General Internal Medicine. 1999;14(5):274–80. - PMC - PubMed
    1. Borowsky SJ, Nelson DB, Nugent SM, Bradley JL, Hamann PR, Stolee CJ, Rubins HB. Characteristics of Veterans Using Veterans Affairs Community-Based Outpatient Clinics. Journal of Health Care for the Poor and Underserved. 2002;13(3):334–46. - PubMed
    1. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases: Implications for Pay for Performance. Journal of the American Medical Association. 2005;294:716–24. - PubMed
    1. Burgess JF, Jr., Maciejewski ML, Bryson CL, Chapko M, Fortney J, Perkins M, Sharp ND, Liu CF. Importance of Health Sector Context for Evaluating Utilization Patterns across Sectors. Journal of Health Economics. 2010 doi 10.1002/hec.1588. - DOI - PubMed

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