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Government Paying Twice for Some Veterans' Healthcare


BACKGROUND:
Some Veterans are eligible to enroll in two federally-funded managed care systems: Medicare Advantage (MA) and VA healthcare. Although VA may collect reimbursements for care provided to Veterans enrolled in private health plans, by law, it is prohibited from collecting any reimbursements from the Medicare program, including MA plans. Therefore, if enrollees in MA plans simultaneously receive Medicare-covered services from another federally-funded provider, and this provider cannot be reimbursed, then the government has made two payments for the same service. Given the severe financial pressure confronting the Medicare program and the federal budget, the nature and extent of services provided to — and the amount of duplicate payments for — these beneficiaries should be quantified. Using national VA and MA administrative data, this retrospective analysis identified 1,245,657 Veterans simultaneously enrolled in VA and MA plans between 2004 and 2009. Investigators also examined the use of outpatient and acute inpatient care in VA and MA, and the costs of Medicare-covered services incurred by VA to care for Veterans enrolled in MA plans.

FINDINGS:

  • The federal government spends a substantial and increasing amount of potentially duplicative funds on two separate managed care programs for care of the same patients. The number of Veterans concurrently enrolled in VA and Medicare Advantage (MA) increased from 485,651 in 2004 to 924,792 in 2009. The estimated VA healthcare costs for MA enrollees totaled $13 billion over six years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009.
  • Among MA plans, the proportion of Veterans eligible for VA healthcare ranged from 0.5% to 21%, and the proportion of VA users within these plans ranged from 0.2% to 16%. For this dually-enrolled patient population, VA financed 44% of outpatient visits, 15% of acute medical and surgical inpatient admissions, and 18% of acute medical and surgical hospital days.

LIMITATIONS:

  • Investigators were unable to quantify the amount of excess federal payments to MA plans on behalf of VA enrollees. Thus, the $13 billion in VA spending over 6 years to provide services to MA enrollees does not represent the precise level of "over-payment" to MA plans.
  • This study was not designed to assess the impact of dual healthcare use on redundant services, uncoordinated care, or health outcomes.

AUTHOR/FUNDING INFORMATION: This study was funded by HSR&D; Dr. Trivedi was supported by an HSR&D Career Development Award. Drs. Trivedi and Mor, and Ms. Grebla and Ms. Jiang are part of HSR&D's Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation, Providence, RI. From 1994 through 1999, Dr. Kizer served as VA's Under Secretary for Health.


PubMed Logo Trivedi A, Grebla R, Jiang L, Yoon J, Mor V, and Kizer K. Duplicative Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System. JAMA 2012 Jul 4;308(1):67-72.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D 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&D 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&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.