Session number: 1009
Abstract title: Population-Based Evaluation of Variation in Medicare Utilization by VAMC Patients.
Author(s):
MJ Barnett - Iowa City VAMC
JM Brooks - University of Iowa, College of Pharmacy
ME Hendel - Iowa Foundation for Medical Care
GE Rosenthal - University of Iowa, College of Medicine & Iowa City VAMC
Objectives: Determine socio-demographic factors associated with the utilization of Medicare services by older VA patients who were eligible for Medicare benefits.
Methods: The study population was drawn from the 24,537 unique patients aged 65 years and older in VISN 14 who utilized VA inpatient or outpatient services in 1998. Patients were identified from the VA Patient Treatment and Outpatient Care files. Using patient identifiers, successful matches with the Medicare Beneficiary files were obtained for 23,654 (96.4%) patients. Analyses determined factors related to the utilization of private sector health care (i.e., Medicare utilization) by these patients and, among users of Medicare services, the influence of distance from a VA facility.
Results: Of the 23,654 VA patients, 15,833 (66.9%) utilized Medicare services. Patients who utilized Medicare services were older than patients who did not utilize Medicare (mean ages, 74 vs. 72 years; p<.001) and more likely (p<.001) to be male (97% vs. 95%), white (97% vs. 94%), and married (70% vs. 56%). Medicare users were less likely (p<.001) to be indigent (i.e., means category A; 71% vs. 81%). Medicare users also had lower VA utilization, as measured by mean total VAMC outpatient clinic stops (16 vs. 23, respectively) and mean VAMC inpatient days (3.6 vs. 4.5) than VA patients who did not use Medicare services. Among the 15,833 Medicare users, Medicare utilization tended to decline as distance from a VA facility increased. Total Medicare expenditures in patients who lived 0-10, 10-30, 30-60, and >60 miles from a VA facility were $1688, $2319, $2371, and $2668, respectively.
Conclusions: In a single Midwest VISN, two-thirds of older VA patients utilized Medicare services during a one-year period. Medicare utilization was directly related to distance from a VA facility. In contrast, veterans who obtained their care exclusively in the VA were somewhat younger, were more likely to be indigent, non-white, and unmarried, and had higher VA utilization.
Impact statement: The substantial cross utilization of VA and Medicare services by older veterans may represent discontinuity of care and global inefficiencies in health care delivery and may stem from differences in VA and Medicare benefits.