Use and Cost of Low-Value Services Among Veterans Dually Enrolled in VA and Medicare.
J Gen Intern Med
; 2024 Jul 08.
Article
em En
| MEDLINE
| ID: mdl-38977515
ABSTRACT
BACKGROUND:
Over half of veterans enrolled in the Veterans Health Administration (VA) are also enrolled in Medicare, potentially increasing their opportunity to receive low-value health services within and outside VA.OBJECTIVES:
To characterize the use and cost of low-value services delivered to dually enrolled veterans from VA and Medicare.DESIGN:
Retrospective cross-sectional.PARTICIPANTS:
Veterans enrolled in VA and fee-for-service Medicare (FY 2017-2018). MAINMEASURES:
We used VA and Medicare administrative data to identify 29 low-value services across 6 established domains cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing, and surgery. We determined the count of low-value services per 100 veterans delivered in VA and Medicare in FY 2018 overall, by domain, and by individual service. We applied standardized estimates to determine each service's cost. KEYRESULTS:
Among 1.6 million dually enrolled veterans, the mean age was 73, 97% were men, and 77% were non-Hispanic White. Overall, 63.2 low-value services per 100 veterans were delivered, affecting 32% of veterans; 22.9 services per 100 veterans were delivered in VA and 40.3 services per 100 veterans were delivered in Medicare. The total cost was $226.3 million (M), of which $62.6 M was spent in VA and $163.7 M in Medicare. The most common low-value service was prostate-specific antigen testing at 17.3 per 100 veterans (VA 55.9%, Medicare 44.1%). The costliest low-value service was percutaneous coronary intervention (VA $10.1 M, Medicare $32.8 M).CONCLUSIONS:
Nearly 1 in 3 dually enrolled veterans received a low-value service in FY18, with twice as many low-value services delivered in Medicare vs VA. Interventions to reduce low-value services for veterans should consider their substantial use of such services in Medicare.
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MEDLINE
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article