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RRP 06-140 – HSR Study

RRP 06-140
Business Case for AMI Care within VHA: Make or Buy Decisions
Mary McDonell, MS
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: May 2006 - September 2006
There is a relatively low volume of acute myocardial infarction (AMI) care in VHA. Despite this, AMI care is very high risk and costly with patients requiring urgent or emergent care. Managers and clinicians are asked to make decisions on whether to invest in current resources or outsource for AMI care either within or outside of VHA. This project analyzed the cost of AMI care in VHA. In particular, it will distinguish between costs of AMI care within VHA and those associated with transfer of AMI patients to outside care.

The study is addressing the following questions:
1.How much did VHA pay for AMI care in fiscal year 2004?
2.How much of this cost was for care provided within VHA?
3.How much was for care paid for by VA but delivered outside VHA (non- VA, fee-basis care)?
4.How did these costs vary by Veterans Integrated Service Network (VISN)?

This is a retrospective, observational study of veterans admitted to a VHA hospital for AMI care and veterans who received inpatient AMI care at a non-VA medical center paid for by VHA during fiscal year 2004. We obtained data on all patients receiving care for AMI who were admitted to a VHA hospital from the External Peer Review Program (EPRP) data. We extracted data on all patients with an ICD-9-CM diagnosis of 410.xx in the VA Fee Basis Files, and merged EPRP data with Decision Support System inpatient cost records. We used Fee Basis files to obtain total costs paid by VA for care outside VHA to enable us to assess the amount of variation in these costs across VISNs.

We found that 6209 AMI patients were admitted to VHA hospitals in FY04. Approximately 750 of these patients and another 4122 VA patients also received VA-paid care outside VHA. Mean cost of care for AMI patients within VHA was $ 15085 (SD $14457). Mean cost of care for VA-paid AMI care outside VHA was $ 13746 (SD $ 11796). Mean costs varied by VISN from $ 9661 to $ 18127 for care provided by VHA and from $ 10795 to $ 24673 for VA-paid care provided outside VHA.

Results suggest that costs of care provided within the VHA system are close to those reported outside VHA. VA-paid costs of care for patients hospitalized outside VHA appear lower than the costs for patients within the system. There is wide variation in costs by VISN. This study provides the first assessment of costs to VA for care provided inside and outside VHA for AMI care, a high burden, high cost health problem affecting large numbers of veterans. Wide variation across VISNs suggests that organizational factors play a major role in how these costs are managed.

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