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Publication Briefs

Significant Duplicative Spending on Coronary Revascularization Procedures among VA and Medicare Dual Enrollees

More than one million Veterans are dually enrolled in a Medicare Advantage (MA) plan and the VA healthcare system. The federal government prepays private MA plans to cover Veterans; thus, if a dually-enrolled Veteran receives an MA-covered service at VA, the government is making two payments for the same service. Moreover, Medicare plans are prohibited by law from making payments for services already paid for by another government entity; thus, VA cannot collect reimbursements from MA plans for Medicare-covered services. This retrospective cohort study sought to describe where dually-enrolled VA-MA Veterans receive coronary revascularization and the associated costs. Among dually-enrolled Veterans (n=18,874) with at least one VA encounter who received coronary revascularization from January 1, 2010 to December 31, 2013, investigators examined the number of coronary artery bypass graft (CABG) surgeries and percutaneous coronary interventions (PCI) performed through VA and MA, and the associated VA costs. In addition, patient factors associated with receiving care through VA were assessed.


  • A significant share of VA healthcare users, concurrently enrolled in a Medicare Advantage plan, received coronary revascularization procedures through VA, incurring significant duplicative federal healthcare spending of nearly $215 million from 2010 through 2013.
  • Over the study period, 4,115 patients (22%) received either CABG or PCI through VA, 14,281 (75%) through MA, and 478 (3%) through both payers. Among this cohort, younger, non-white Veterans living in urban and rural counties were more likely to receive CABG or PCI through VA, whereas distance to a VA hospital did not independently influence the choice of VA versus MA for coronary revascularization.


  • The growing number of Medicare beneficiaries opting into Medicare Advantage is likely to lead to an increase in duplicative billing. Given the financial pressures facing both Medicare and VA, government officials should consider policy solutions to mitigate duplicative federal spending.


  • Investigators lacked detailed clinical information.
  • Outside of fee-basis care, VA expenditures were estimated because VA does not assign costs nor charge for individual services.

This study was partly funded by HSR&D (IIR 14-077). Dr. Groeneveld is part of HSR&D’s Center for Health Equity Research and Promotion (CHERP). Drs. Dayoub, Epstein, Groeneveld, and Ms. Medvedeva are with the Michael J. Crescenz VA Medical Center, Philadelphia, PA

PubMed Logo Dayoub E, Medvedeva E, Khatana S, Nathan A, Epstein A, and Groeneveld P. Federal Payments for Coronary Revascularization Procedures among Dual Enrollees in Medicare Advantage and the Veterans Affairs Health Care System. JAMA Network Open. April 6, 2020;3(4):e201451.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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