scholarly journals Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110579
Author(s):  
Todd H. Wagner ◽  
Jeanie Lo ◽  
Erin Beilstein-Wedel ◽  
Megan E. Vanneman ◽  
Michael Shwartz ◽  
...  
Keyword(s):  
Average Cost ◽  
Surgical Care ◽  
Risk Scores ◽  
Fiscal Year ◽  
Veterans Health ◽  
Health Administration ◽  
Complex Patients ◽  
Risk Patients ◽  
Community Providers ◽  
The Cost

Background. Veterans’ access to Veterans Affairs (VA)-purchased community care expanded due to large increases in funding provided in the 2014 Veterans Choice Act. Objectives. To compare costs between VA-delivered care and VA payments for purchased care for two commonly performed surgeries: total knee arthroplasties (TKAs) and cataract surgeries. Research Design. Descriptive statistics and regressions examining costs in VA-delivered and VA-purchased care (fiscal year [FY] 2018 [October 2017 to September 2018]). Subjects. A total of 13,718 TKAs, of which 6,293 (46%) were performed in VA. A total of 91,659 cataract surgeries, of which 65,799 (72%) were performed in VA. Measures. Costs of VA-delivered care based on activity-based cost estimates; costs of VA-purchased care based on approved and paid claims. Results. Ninety-eight percent of VA-delivered TKAs occurred in inpatient hospitals, with an average cost of $28,969 (SD $10,778). The majority (86%) of VA-purchased TKAs were also performed at inpatient hospitals, with an average payment of $13,339 (SD $23,698). VA-delivered cataract surgeries were performed at hospitals as outpatient procedures, with an average cost of $4,301 (SD $2,835). VA-purchased cataract surgeries performed at hospitals averaged $1,585 (SD $629); those performed at ambulatory surgical centers cost an average of $1,346 (SD $463). We also found significantly higher Nosos risk scores for patients who used VA-delivered versus VA-purchased care. Conclusions. Costs of VA-delivered care were higher than payments for VA-purchased care, but this partly reflects legislative caps limiting VA payments to community providers to Medicare amounts. Higher patient risk scores in the VA could indicate that community providers are reluctant to accept high-risk patients because of Medicare reimbursements, or that VA providers prefer to keep the more complex patients in VA.

scholarly journals The impact of benchmarking operating room efficiency within the Veterans Health Administration

2018 ◽  
Vol 5 (1) ◽  
pp. 8
Author(s):  
Marilyn Lynn ◽  
Douglas Bronson ◽  
William Gunnar
Keyword(s):  
Operating Room ◽  
Surgical Care ◽  
Veterans Health Administration ◽  
Fiscal Year ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Or Efficiency ◽  
Internal Benchmarking ◽  
The Impact

Purpose: The Department of Veterans Affairs (VA) provides surgical care and services through a network of Veterans Health Administration (VHA) Surgical Programs. This study examined the impact of benchmarking on improvements in VHA surgery program operating room efficiency.Methods: The VA National Surgery Office (NSO) developed the operating room (OR) Efficiency Matrix with four common metrics that characterize OR processes. The OR Efficiency Matrix assigned a performance level to each VHA Surgery Program identified in the NSO Quarterly Report. The NSO Quarterly Report provided ongoing and regular feedback allowing VHA Surgery Programs to develop action plans and improve performance.Results: Beginning with the Fiscal Year (FY) 2013 Quarter (Q) 2 NSO Quarterly Report, the NSO has been reporting to VHA Surgery Programs on the OR Efficiency Matrix through several tables and figures in the NSO Quarterly Report. Overall, raw metric rates have improved nationally, with most improvements coming in the metrics of OR first time starts and surgical case cancellation.Conclusions: The NSO developed and implemented the OR Efficiency Matrix, representing four well recognized metrics, to assess, track, and report OR efficiency at 137 VHA Surgery Programs. This internal benchmarking process and data reporting was associated with sustainable improvements in OR efficiency over time.

scholarly journals Novel Methodology to Measure Preprocedure Antimicrobial Prophylaxis: Integrating Text Mining With Structured Data

2020 ◽  
Vol 41 (S1) ◽  
pp. s12-s13
Author(s):  
Hillary Mull ◽  
Kelly Stolzmann ◽  
Emily Kalver ◽  
Marlena Shin ◽  
Marin Schweizer ◽  
...  
Keyword(s):  
Antimicrobial Prophylaxis ◽  
High Sensitivity ◽  
Structured Data ◽  
Fiscal Year ◽  
Veterans Health ◽  
Health Administration ◽  
Implementation Barriers ◽  
Cardiac Device ◽  
Device Infection ◽  
Manual Review

Background: Antimicrobial prophylaxis is an evidence-proven strategy for reducing procedure-related infections; however, measuring this key quality metric typically requires manual review, due to the way antimicrobial prophylaxis is documented in the electronic medical record (EMR). Our objective was to combine structured and unstructured data from the Veterans’ Health Administration (VA) EMR to create an electronic tool for measuring preincisional antimicrobial prophylaxis. We assessed this methodology in cardiac device implantation procedures. Methods: With clinician input and review of clinical guidelines, we developed a list of antimicrobial names recommended for the prevention of cardiac device infection. Next, we iteratively combined positive flags for an antimicrobial order or drug fill from structured data fields in the EMR and hits on text string searches of antimicrobial names documented in electronic clinical notes to optimize an algorithm to flag preincisional antimicrobial use with high sensitivity and specificity. We trained the algorithm using existing fiscal year (FY) 2008-15 data from the VA Clinical Assessment Reporting and Tracking-Electrophysiology (CART-EP), which contains manually determined information about antimicrobial prophylaxis. We then validated the performance of the final version of the algorithm using a national cohort of VA patients who underwent cardiac device procedures in FY 2016 or 2017. Discordant cases underwent expert manual review to identify reasons for algorithm misclassification and to identify potential future implementation barriers. Results: The CART-EP dataset included 2,102 procedures at 38 VA facilities with manually identified antimicrobial prophylaxis in 2,056 cases (97.8%). The final algorithm combining structured EMR fields and text-note search results flagged 2,048 of the CART-EP cases (97.4%). Algorithm validation identified antimicrobial prophylaxis in 16,334 of 19,212 cardiac device procedures (87.9%). Misclassifications occurred due to EMR documentation issues. Conclusions: We developed a methodology with high accuracy to measure guideline-concordant use of antimicrobial prophylaxis before cardiac device procedures using data fields present in modern EMRs that does not rely on manual review. In addition to broad applicability in the VA and other healthcare systems with EMRs, this method could be adapted for other procedural areas in which antimicrobial prophylaxis is recommended but comprehensive measurement has been limited to resource-intense manual review.Funding: NoneDisclosures: None

scholarly journals Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation

BMJ ◽  
2020 ◽  
pp. m283 ◽  
Author(s):  
Elizabeth M Oliva ◽  
Thomas Bowe ◽  
Ajay Manhapra ◽  
Stefan Kertesz ◽  
Jennifer M Hah ◽  
...  
Keyword(s):  
Opioid Analgesic ◽  
Veterans Health Administration ◽  
Fiscal Year ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Treatment ◽  
Risk Of Death ◽  
Length Of Treatment ◽  
Increased Risk ◽  
Stopping Treatment

Abstract Objective To examine the associations between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration. Design Observational evaluation. Setting Veterans Health Administration. Participants 1 394 102 patients in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from fiscal year 2013 to the end of fiscal year 2014 (1 October 2012 to 30 September 2014). Main outcome measures A multivariable Cox non-proportional hazards regression model examined death from overdose or suicide, with the interaction of time varying opioid cessation by length of treatment (≤30, 31-90, 91-400, and >400 days) as the main covariates. Stopping treatment with opioids was measured as the time when a patient was estimated to have no prescription for opioids, up to the end of the next fiscal year (2014) or the patient’s death. Results 2887 deaths from overdose or suicide were found. The incidence of stopping opioid treatment was 57.4% (n = 799 668) overall, and based on length of opioid treatment was 32.0% (≤30 days), 8.7% (31-90 days), 22.7% (91-400 days), and 36.6% (>400 days). The interaction between stopping treatment with opioids and length of treatment was significant (P<0.001); stopping treatment was associated with an increased risk of death from overdose or suicide regardless of the length of treatment, with the risk increasing the longer patients were treated. Hazard ratios for patients who stopped opioid treatment (with reference values for all other covariates) were 1.67 (≤30 days), 2.80 (31-90 days), 3.95 (91-400 days), and 6.77 (>400 days). Descriptive life table data suggested that death rates for overdose or suicide increased immediately after starting or stopping treatment with opioids, with the incidence decreasing over about three to 12 months. Conclusions Patients were at greater risk of death from overdose or suicide after stopping opioid treatment, with an increase in the risk the longer patients had been treated before stopping. Descriptive data suggested that starting treatment with opioids was also a risk period. Strategies to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The associations observed cannot be assumed to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and was not investigated. Safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient’s perspective. Factors to address are those that place patients at risk for overdose or suicide after beginning and stopping opioid treatment, especially in the first three months.

Cost of Outpatient Blood Transfusion in Cancer Patients

2000 ◽  
Vol 18 (14) ◽  
pp. 2755-2761 ◽  
Author(s):  
Pierre-Yves Crémieux ◽  
Barbara Barrett ◽  
Kenneth Anderson ◽  
Mitchell B. Slavin
Keyword(s):  
Cancer Patients ◽  
Solid Tumors ◽  
Average Cost ◽  
Flow Diagram ◽  
Fiscal Year ◽  
Cancer Center ◽  
Tumor Type ◽  
Substantial Impact ◽  
Pediatric Cancer Patients ◽  
The Cost

PURPOSE: To determine the cost of outpatient RBC transfusion from the provider’s perspective at a major urban, academic cancer center. PATIENTS AND METHODS: We retrospectively studied 517 cancer patients with hematologic or solid tumors who received blood during fiscal year 1995 to 1996. A process-flow diagram was developed, and cost and utilization data for 12 months were collected and analyzed. A structured interview process was used to identify all direct and indirect costs from within the inpatient unit, blood bank, and outpatient clinic. Average costs were computed for the entire sample and for specific subgroups. RESULTS: In 1998 dollars, the average cost per RBC unit was $469 for adults and $568 for pediatric cancer patients. Adults and children generally received two and one RBC units per transfusion, respectively. Therefore, the average cost of a two-unit transfusion was $938 for adults. Patients with hematologic tumors required more RBC units (7.1 RBC units per year) at a higher average cost ($512 per RBC unit) than patients with solid tumors (4.7 RBC units per year, $474 per RBC unit). Further variations across tumor types were observed. Overhead, direct material, and direct labor represented 46%, 19%, and 35% of total costs respectively. CONCLUSION: The cost of outpatient RBC transfusions in cancer patients is higher than previously reported, in part because overhead costs and fixed costs might have been underestimated in previous studies. Furthermore, age, tumor type, and geographic variations in the cost of fixed assets and labor have a substantial impact on the cost of blood. The results indicate that the cost-effectiveness of alternatives to transfusions in the management of cancer patients may have been underestimated in the existing literature.

Assessing the cost-effectiveness of COX-2 specific inhibitors for arthritis in the Veterans Health Administration

2004 ◽  
Vol 21 (1) ◽  
pp. 47-60 ◽  
Author(s):  
Monica Schaefer ◽  
Melissa DeLattre ◽  
Xin Gao ◽  
Jennifer Stephens ◽  
Marc Botteman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Cox 2 ◽  
The Cost ◽  
Specific Inhibitors

The Management of Newly-Diagnosed Non-muscle Invasive Bladder Cancer in Veterans Integrated Services Network 02 of the Veterans Health Administration

2019 ◽  
Author(s):  
Joseph M Caputo ◽  
George Moran ◽  
Benjamin Muller ◽  
Alison T Keller ◽  
Gen Li ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Newly Diagnosed ◽  
Health Administration ◽  
Muscle Invasive Bladder Cancer ◽  
High Risk Patients ◽  
Risk Patients ◽  
Muscle Invasive

Abstract Introduction Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Health Administration. The objective of the study was to assess the quality of care for Veterans with newly-diagnosed NMIBC within Veterans Integrated Service Network (VISN) 02. Materials and Methods We used ICD-9 and ICD-10 codes to identify patients with newly-diagnosed bladder cancer from 1/2016–8/2017. We risk-stratified the patients into low, intermediate, and high-risk based on the 2016 American Urological Association Guidelines on NMIBC. Our primary objectives were percentages of transurethral resection of bladder tumors (TURBTs) with detrusor, repeat TURBT in high-risk and T1 disease, high-risk NMIBC treated with induction intravesical therapy (IVT), and responders treated with maintenance IVT. We performed logistic regression for association between distance to diagnosing hospital and receipt of induction IVT in high-risk patients. Results There were 121 newly-diagnosed NMIBC patients; 16% low-risk, 28% intermediate-risk, and 56% high-risk. Detrusor was present in 80% of all initial TURBTs and 84% of high-risk patients. Repeat TURBT was performed in 56% of high-risk NMIBC and 60% of T1. Induction IVT was given to 66% of high-risk patients and maintenance IVT was given to 59% of responders. On multivariate logistic regression, distance to medical center was not associated with receipt of induction IVT (OR = 0.99, 95% CI [0.97,1.01], p = 0.52). Conclusions We observed high rates of sampling of detrusor in the first TURBT specimen, utilization of repeat TURBT, and administration of induction and maintenance intravesical BCG for high-risk patients among a regional cohort of US Veterans with NMIBC. While not a comparative study, our findings suggest high quality NMIBC care in VA VISN 02.

Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity

2018 ◽  
Vol 14 (3) ◽  
pp. 171-182 ◽  
Author(s):  
Theddeus Iheanacho, MD ◽  
Elina Stefanovics, PhD ◽  
Robert Rosenheck, MD
Keyword(s):  
Risk Factor ◽  
Service Use ◽  
Veterans Health Administration ◽  
Opioid Use Disorder ◽  
Fiscal Year ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Homeless Veterans

Objective: The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA).Design: Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD.Results: Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent).Conclusions: OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.

scholarly journals The Veterans Health Administration: A Preliminary Analysis of the Influence of The Independent Budget and Bureaucratic Performance on Funding Trends

2008 ◽  
Vol 15 (1) ◽  
pp. 5
Author(s):  
Elizabeth Kidder
Keyword(s):  
Veterans Health Administration ◽  
Service Organizations ◽  
The Political ◽  
Veterans Health ◽  
Health Administration ◽  
The Past ◽  
Bureaucratic Performance ◽  
The Cost ◽  
The Impact

The Veterans Health Administration (VHA) is the largest integrated health system in the U.S. with 7.9 million U.S. veterans enrolled.  Both the number of veterans seeking VHA health services and the cost of delivering such services continue to rise as a result of myriad factors. Kidder examines VHA funding outcomes over the past 10 years in light of the participation of veterans' service organizations (VSOs) in committee hearings; the reliance of lawmakers upon The Independent Budget (IB); and the impact of new performance-based management initiatives on budget outcomes.  Her article highlights the political nature of the VHA budget and the influential role of VSOs in funding outcomes.

scholarly journals Legionella in the veterans healthcare system: report of an eight-year survey

2003 ◽  
Vol 131 (2) ◽  
pp. 835-839 ◽  
Author(s):  
A. A. KELLY ◽  
L. H. DANKO ◽  
S. M. KRALOVIC ◽  
L. A. SIMBARTL ◽  
G. A. ROSELLE
Keyword(s):  
Healthcare System ◽  
Positive Outcome ◽  
The United States ◽  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Fiscal Year ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Healthcare Associated

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3·62 million persons were served by the VHA. From fiscal year 1989–1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992–1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95·5% respectively (P=0·005 and 0·01). Case rates also decreased significantly for community and healthcare-associated cases (P=0·02 and 0·001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P=0·02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P=0·02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.

Financial toxicity among veterans with cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 103-103
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Sana Khateeb ◽  
Manali I. Patel
Keyword(s):  
Financial Burden ◽  
Demographic Factors ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Financial Toxicity ◽  
Validated Questionnaire ◽  
Academic Center ◽  
Single Payer ◽  
The Cost

103 Background: Financial toxicity of cancer care has not previously been studied within the Veterans Health Administration (VHA). The VHA provides health care for veterans in VA hospitals across the United States (US). It is a single-payer system and the largest integrated health system in the US and in this study we sought to assess financial toxicity experienced by veterans at a VA hospital. Methods: We asked veterans with oncology clinic visits at the VA Palo Alto to complete a survey that included an 11-item validated questionnaire called the COST tool. The COST tool calculates a score 0-44 with higher scores suggestive of higher financial toxicity. We also assessed demographic factors including gender, education, race, income, and insurance status as well as monthly out of pocket costs (OOPC) and suggested resources to reduce burden. We coded responses and calculated descriptive statistics with proportions. Results: A total of 84 veterans completed the survey and demographic factors are depicted in Table. Veterans were predominantly male (96%), high school or less educated (46%), white (61%), with annual income less than $50,000 (81%), and VA insurance (95%). The mean COST score was 21. The majority of veterans (63%) reported less than $100 of monthly OOPC and many (56%) reported transportation as a major expense and requested transportation resources. Conclusions: Financial toxicity is an unmet concern among veterans. Despite low monthly OOPC in the VHA single-payer system, financial toxicity as measured by the COST score at a VA hospital was as high as a nearby academic center. Transportation was the most significant expense and future studies should evaluate interventions to reduce the financial burden of transportation for veterans. [Table: see text]

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