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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1040 — The Use and Cost of Low-Value Services Delivered to Veterans through the Veterans Health Administration and Medicare

Lead/Presenter: Thomas Radomski,  COIN - Pittsburgh/Philadelphia
All Authors: Radomski TR (Center for Health Equity Research and Promotion, Pittsburgh), Zhao X (Center for Health Equity Research and Promotion, Pittsburgh) Lovelace EZ (Center for Health Equity Research and Promotion, Pittsburgh) Sileanu FE (Center for Health Equity Research and Promotion, Pittsburgh) Rose L (Health Economics Resource Center, Palo Alto) Schwartz AL (Center for Health Equity Research and Promotion, Philadelphia) Pickering AN (Center for Health Equity Research and Promotion, Pittsburgh) Hale JA (Center for Health Equity Research and Promotion, Pittsburgh) Schleiden LJ (Center for Health Equity Research and Promotion, Pittsburgh) Gellad WF (Center for Health Equity Research and Promotion, Pittsburgh) Fine MJ (Center for Health Equity Research and Promotion, Pittsburgh) Thorpe CT (Center for Health Equity Research and Promotion, Pittsburgh)

Objectives:
Low-value care is common in the Veterans Health Administration (VA), resulting in wasteful healthcare spending and unnecessary harm to Veterans. Nearly all VA beneficiaries aged > = 65 years are dually enrolled in Medicare, placing them at increased risk of receiving low-value services outside VA. Our objective was to characterize the use and cost of low-value services received by Veterans within VA and outside VA through Medicare.

Methods:
We compiled a national cohort of Veterans who were continuously enrolled in VA and Medicare in fiscal years (FY) 2017-2018 and received care in VA in FY2018. We used administrative data to identify 29 low-value services across 6 domains: imaging, cancer screening, pre-operative testing, diagnostic and preventive testing, cardiac testing, and surgery. Within VA and Medicare, we determined the count of low-value services per 100 Veterans delivered in FY 2018 and the percentage of Veterans who received a low-value service in VA, Medicare, or through both sources. To determine the cost of care, we applied service-specific cost estimates based on average national reimbursement rates in Medicare, incorporating facility-fees and related ancillary services (e.g., venipuncture for blood tests) when applicable.

Results:
Among the 1.4 million (M) dually enrolled Veterans in the cohort, the mean age was 76 (SD 7.6), 97.9% were male, 84.3% were non-Hispanic white, and 79.9% received any health service through Medicare in FY 2018. Overall, 33.8% of Veterans received a low-value service, costing $140M. Within VA, 19.1 services per 100 Veterans were delivered, affecting 16.5% of Veterans at a cost of $38.8M. Within Medicare, 27.7 services per 100 Veterans were delivered, affecting 21.2% of Veterans at a cost of $101.5M. A total of 3.9% of Veterans received low-value services from both VA and Medicare. Except for cancer screening, low-value services were more commonly delivered through Medicare across all domains. For example, the total count of low-value imaging tests delivered in VA was 4.6/100 Veterans, whereas the count in Medicare was 14.5/100 Veterans. The most common individual low-value service was unnecessary prostate cancer screening, with a count of 11.1/100 Veterans in VA and 8.8/100 in Medicare. The costliest low-value service was unnecessary percutaneous coronary intervention, costing $11.5M in VA and $30M in Medicare.

Implications:
Among a national cohort of Veterans dually enrolled in VA and Medicare, 1 in 3 received a low-value service in FY 2018 at a total cost of $140M. Except for cancer screening, most low-value services were delivered via Medicare.

Impacts:
These findings demonstrate the importance of understanding Veterans’ receipt of low-value services within and outside VA to most effectively improve the overall value of care that they receive.