3051 — Factors Associated with Veterans’ Dual Use of VA and Medicare Primary Care Services

Maciejewski ML (Durham HSR&D), Burgess J (Boston HSR&D (COLMR)), Bryson CL (Seattle HSR&D), Perkins M (Seattle HSR&D), Fortney JC (Little Rock HSR&D), Manning WG (University of Chicago), Chapko M (Seattle HSR&D), Sharp N (Seattle HSR&D), Liu CF (Seattle HSR&D)

Objectives:
Medicare eligible veterans can obtain primary care services through VA or Medicare, but there is no understanding of which types of veterans use each system. This study examined patient factors associated with veterans’ dual use of VA and Medicare primary care services in 2000-2004.

Methods:
The study sample included 20,512 veterans who obtained primary care in CBOCs or VAMC primary care clinics in fiscal year 2000, were eligible for Medicare due to age or disability, and had used primary care only through VA (n=14,422) or through VA and Medicare (n=6,090) in 2000. Based on provider type and CPT codes in VA and Medicare outpatient visit data, we identified which veterans obtained primary care only through VA, through VA and Medicare, or only through Medicare. We estimated a generalized estimating equation to examine dual use of VA and Medicare primary care services in 2001-2004 (n=82,048 person-years), controlling for demographics, CBOC use, comorbidities, distance to the nearest VAMC, and Census-based per capita income and education attainment in the veteran’s zip code of residence.

Results:
Veterans were more likely to use primary care services through VA and Medicare if they were CBOC users, were female, were over age 65, were Caucasian, were married, had lower DCG risk scores, had COPD or diabetes, were depressed, did not have alcohol use problems, lived closer to a VA medical center, or lived in zipcodes with higher per capita incomes. VA only use declined in 2001-2004 and dual use of VA and Medicare primary care services declined in 2001-2002 but then stabilized, possibly because more veterans were obtaining primary care only through Medicare.

Implications:
Medicare-eligible veterans already using community-based care via CBOCs were more likely to dually use VA and Medicare primary care services. Declining use of VA only use and dual use may suggest that veterans transition to Medicare over time.

Impacts:
VA providers may need to coordinate with non-VA providers to ensure their Medicare-eligible patients receive appropriate primary care. Future research should examine the differences in dual use between age-eligible and disability-eligible veterans, and what types of veterans persistently used both systems for primary care, and how dual use impacts veteran’s continuity of primary care.