Are Rates of Skin Procedures Higher in Veterans Health Administrations Purchased Care Than Veterans Health Administrations Delivered Care?

Dizon MP, Asch SM, Wagner TH. Are Rates of Skin Procedures Higher in Veterans Health Administrations Purchased Care Than Veterans Health Administrations Delivered Care? Medical care. 2025 Aug 1; 63(8):555-562, DOI: 10.1097/MLR.0000000000002151.

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Abstract:

BACKGROUND: To improve access to care, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program, allowing enrollees to receive care outside VA facilities if they met eligibility requirements tied to wait times, travel, and availability of services. VA-purchased care has grown significantly to more than $32 billion in 2024, representing 24% of VA''s medical care budget. OBJECTIVES: To compare the annual utilization of skin procedures for Veterans who received only VA-purchased care versus any VA-delivered care. RESEARCH DESIGN: Using medical records and claims data, we conducted a retrospective cohort study of Veterans who received outpatient evaluation and management (E/M) services and skin procedures delivered or purchased by the VA during the era of the Veterans Choice Program (VCP) from January 1, 2015, to June 5, 2019. We examined the annual utilization of outpatient procedures and E/M services and adjusted for demographic and clinical characteristics using zero-inflated Poisson regression models and propensity score matching. RESULTS: VA-purchased care was associated with greater utilization for all skin procedures examined. For the most common procedures, destruction of premalignant lesions and biopsies, annual rates were 1.4-fold and 1.5-fold greater in the VA-purchased care group, respectively. CONCLUSIONS: The growth of purchased community care is a concern if it reflects a growth of low-value services. If the resource-intensive purchased care were unnecessary, it would pose risks for VA and Veterans, and alternative payment models should be explored to limit this risk.