VA Patients Have Fewer Avoidable Hospitalizations Post-Chemotherapy than Medicare Patients

January 28, 2021

Takeaway: Results of an HSR&D-funded study – driven by recent legislation (Choice Act of 2014, MISSION Act of 2018) allowing Veterans to seek care in the private sector if VA care is difficult to access – indicate that Veterans with cancer receive higher-quality care in VA than in fee-for-service settings with respect to avoidable hospitalizations post-chemotherapy, suggesting policymakers should monitor implications in quality of care external to VA.

In recognition that many side effects of chemotherapy can be appropriately managed to avoid acute care utilization, the Centers for Medicare and Medicaid Services (CMS) released a new quality measure to reduce potentially-avoidable hospital admissions among patients receiving outpatient chemotherapy. In this HSR&D-funded study, investigators used this CMS measure to compare the quality of care received by Veterans receiving chemotherapy through Fee-for-Service (FFS) Medicare versus VA, using a cohort of Veterans who were dually enrolled in VA and Medicare. Investigators identified 27,433 Veterans aged 66 and older who died from cancer between FY2010 and FY2014 – and who had received chemotherapy through Medicare (17,921 Veterans or 65% of cohort) or VA (9,522 Veterans or 35% of cohort). Findings show:

• Veterans with cancer receiving chemotherapy through VA have higher-quality care with respect to avoidable hospitalizations than Veterans receiving chemotherapy through Medicare. In adjusted models, roughly 7% of Veterans treated through Medicare had potentially avoidable hospitalizations in the 30 days following chemotherapy compared with approximately 5% of Veterans treated by VA.

Impacts

This study was driven by recent legislation (Choice Act of 2014, MISSION Act of 2018) allowing Veterans to seek care in the private sector if VA care is difficult to access. As these policy changes are implemented, it is critical to understand whether this shift in system of care will impact care quality, especially for conditions as serious as cancer. These results indicate Veterans with cancer receive higher-quality care in VA than in fee-for-service settings with respect to avoidable hospitalizations post-chemotherapy, suggesting policymakers should monitor implications in quality of care external to VA.

Gidwani-Marszowski R, Faricy-Anderson K, Asch S, et al. Potentially avoidable hospitalizations after chemotherapy: Differences across Medicare and the Veterans Health Administration. Cancer. July 15, 2020;126(14):3297-3302.

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