- Veterans seeking cardiac care at community hospitals may lower their travel expenses, but they also face varying healthcare costs and mortality rates by stepping outside the VA’s healthcare system, a recent JAMA Cardiology study revealed.
The analysis of over 19,190 elective coronary revascularizations between Oct. 2008 and Sept. 2011 at VA and community hospitals showed that veterans who underwent elective percutaneous coronary interventions (PCI) at community hospitals traveled 56.3 miles less and incurred $153 less in travel expenses than if they went to a VA hospital.
But the mean adjusted cost of the index PCI procedure was over $6,300 more, reaching a total of $22,025 for the elective surgery at community hospitals.
Total costs to the patient were also higher at community hospitals. PCI patients incurred over $6,200 more in index procedure, readmission, and travel costs compared to similar patients at VA hospitals.
Additionally, veterans faced higher 30-day mortality rates at community versus VA hospitals. Researchers reported that adjusted 30-mortality rates at community hospitals were 1.54 percent during the study’s period versus 0.65 percent at VA hospitals.
But higher 30-day mortality rates at community hospitals for PCI patients did not necessarily indicate lower care quality, researchers pointed out.
“Other possible factors include delay in making care arrangements, incomplete coordination of care between VA and CC [community care] hospitals, or failure to refill medications prescribed by CC clinicians,” they elaborated. “These are obvious areas for future research and quality improvement efforts. New VA data on scheduling of care, including a database of CC approvals, will help the VA detect problems associated with treatment delay.”
While VA hospitals performed better in terms of costs and outcome for PCI procedures, community hospitals fared better with costs and outcomes for elective coronary artery bypass grafting (CABG) procedures.
Veterans who used community hospitals for CABG surgery traveled 73.3 miles less and incurred $690 less in travel expenses on average.
They also had incurred fewer healthcare costs for CABG procedures. The mean adjusted cost of the index CABG procedure was $7,600 less and total costs were $8,500 less at community versus VA hospitals.
Mortality rates were similar for veterans treated in community and VA hospitals, researchers added.
The study’s findings could have a significant impact on the VA’s Community Care Program, researchers explained. The program allows veterans to seek care beyond the VA healthcare system if patients face a lack of available specialists, long wait times, or extraordinary travel distance.
The Community Care Program cost $5.6 billion in 2014, representing about 10 percent of the VA’s healthcare budget. The program’s budget and influence may grow as VA officials contemplate a potential program expansion to improve patient access.
But officials and policymakers may want to reconsider if encouraging veterans to undergo PCI procedures in community hospitals will decrease healthcare costs and improve care quality. Veterans and other healthcare stakeholders lack publicly available data on hospital quality and mortality rates, researchers explained. Without the necessary information, veterans may not be able to choose a high-quality, cost-effective community hospital.
The administration may also fail to contract with high-value community hospitals.
“The VA currently requires CC providers to have an active license and a lack of sanctions but does not set minimum quality thresholds or choose hospitals based on cost,” wrote researchers.
“Better information on the characteristics of CC patients and the hospitals that care for them could improve VA decision-making.”
The VA should acquire data to evaluate community hospital care quality, including performance on measures based on the national registries of PCI and CABG surgery, they suggested.
“This process could allow the VA to selectively contract with hospitals that meet standards of both quality and transparency.”
The VA should also consider increasing capacity at high-performing VA hospitals instead of increasing outsourced care to the community, researchers added. The study showed that care quality at VA hospitals is similar to care delivered at community hospitals.
However, VA hospitals have significantly lower procedure volumes that are less than the recommended minimum.
Promoting PCI procedures at high-value VA facilities could help the VA to decrease healthcare costs while improving care quality for veterans.