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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3034 — Financial and Travel Time Ramifications of Moving VA CABG Care to the Private Sector in New York

Author List:
Weeks WB (VA Outcomes Group, NCPS, VAQS, Dartmouth Medical School)
Summerall EL (VA Quality Scholars Fellowship Program)

Objectives:
VA is focusing on improving the quality of cardiac care provided within the VA system; however, no VA cardiac care center performs more than 500 coronary artery bypass graft (CABG) surgeries annually, the minimum volume associated with improved outcomes. We sought to understand the financial and travel time implications of directing veterans’ CABG care to either meet volume standards within the VA system or contract care to high volume private sector CABG centers.

Methods:
We performed a retrospective analysis of 1415 male New York State residents who were enrolled in the VA and obtained isolated, non-emergent CABG surgery in the VA or the private sector in 2000. We determined Medicare enrollment status and payer for care, then modeled financial and travel time implications of moving care from the private sector to the VA, and vice versa, from a taxpayer perspective.

Results:
Most VA patients (83%) obtained their CABG surgeries in the private sector. Patients who used the private sector were more often enrolled in Medicare Part A (86.6% vs. 67.5%, p<.001) and Part B (81.8% vs. 54.9%, p<.001). Medicare paid for 82% of private sector care and 25% of private sector care required patient co-payments. Modeled costs of CABG care were $34.5 million in 2000; patients incurred $8.7 million of that amount and traveled much longer (45 vs. 22 minutes) to obtain CABG care in the VA. Costs would increase to $45.8 million if enough private sector care were directed to the VA to meet minimum volume standards, and to $52 million if all private sector care were directed to the VA. Directing all VA care to high volume centers in the private sector, would decrease costs to $31 million and travel burden to 15 minutes. Should cost savings be used to eliminate veterans’ out-of-pocket costs, taxpayers would still realize cost savings of $800,000.

Implications:
Directing VA CABG care to the private sector could reduce veterans’ travel burden, allow VA patients to obtain care in high volume CABG centers, save money, and subsidize veterans’ out-of-pocket costs.

Impacts:
VA should consider partnering with Medicare to pilot such a program.


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