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Health Services Research & Development

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HSR&D Citation Abstract

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Rosenthal GE, Lampman MA, McCoy K, Vaughan-Sarrazin MS. Use of VA and Medicare Services by Dually Eligible Veterans Receiving VA Primary Care After Implementation of Patient Aligned Care Teams (PACT). Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
Abstract: Objectives Examine changes in utilization patterns of VA and non-VA services by Veterans in VA primary care clinics after implementation of the PACT model in 2010. Methods Merged VA and Medicare administrative data for patients 65 years and older in 2010 (n = 1,282,542) and 2012 (n = 1,128,190) were used to compare utilization of outpatient and inpatient services in patients receiving primary care in VA medical centers (VAMCs) and community based outpatient clinics (CBOCs). Inpatient services were categorized using DRGs; outpatient services were categorized using provider specialty codes. Results In 2010, Veterans receiving primary care in CBOCs were more likely (p < .001) to receive concurrent Medicare primary care services (51.3% vs. 38.8%) than Veterans in VAMCs; while Veterans in VAMCs were more likely (p < .001) to receive outpatient specialty care from the VA than Medicare (44.0% vs. 61.9%). While these patterns were consistent in 2012, the overall proportion of Veterans receiving Medicare services declined for primary care (44.9% in 2010 vs. 39.9% in 2012) and outpatient specialty care (53.9% in 2010 vs. 48.4% in 2012). Declines in use of Medicare services were consistent in VAMC and CBOC patients when examined separately. In contrast, use of VA outpatient specialty services increased (p < .001) in all patients (53.2% in 2010 vs. 55.8% in 2012) and for VAMC (61.9% vs. 64.6%) and CBOC (44.0% vs. 47.2%) patients. While Veterans were more likely to receive inpatient medical and surgical services through Medicare than the VA, use of the VA increased somewhat between 2010 and 2012 for medical (6.5% vs. 7.2%) and surgical services (2.3% vs. 2.4%), while the use of Medicare declined somewhat between 2010 and 2012 for inpatient medical (13.3% vs. 13.2%) and surgical (6.6% vs. 5.7%) services. Conclusion A significant proportion of Medicare eligible Veterans receive care from both the VA and Medicare. However, implementation of the PACT model was associated with a greater reliance on VA services. Impact Evaluations of the quality and cost of VA care must account for the use of non-VA services. Failure to account for such utilization may lead to biased estimates of the impact of PACT and other changes in VA healthcare delivery on healthcare utilization.

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