Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System

被引:39
|
作者
Trivedi, Amal N. [1 ,2 ]
Grebla, Regina C. [1 ,2 ]
Jiang, Lan [1 ]
Yoon, Jean [3 ]
Mor, Vincent [1 ,2 ]
Kizer, Kenneth W. [4 ]
机构
[1] Providence VA Med Ctr, Providence, RI 02908 USA
[2] Brown Univ, Alpert Med Sch, Providence, RI 02912 USA
[3] Palo Alto VA Med Ctr, Palo Alto, CA USA
[4] Univ Calif Davis, Sacramento, CA 95817 USA
来源
关键词
VA; HMOS; HOSPITALS; DISTANCE; SERVICES; LEVEL;
D O I
10.1001/jama.2012.7115
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan. Objective To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees. Design Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004-2009. Main Outcome Measures Use of health services and inflation-adjusted estimated VA health care costs. Results Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees to-taled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n=21 353 841), 15% of all acute medical and surgical admissions (n=177 663), and 18% of all acute medical and surgical inpatient days (n=1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care). Conclusions The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals. JAMA. 2012;308(1):67-72 Published online June 26, 2012. doi: 10.1001/jama.2012.7115 www.jama.com
引用
下载
收藏
页码:67 / 72
页数:6
相关论文
共 50 条
  • [41] Use of preventive care by elderly male veterans receiving care through the Veterans Health Administration, medicare fee-for-service, and medicare HMO plans
    Keyhani, Salomeh
    Ross, Joseph S.
    Hebert, Paul
    Dellenbaugh, Cornelia
    Penrod, Joan D.
    Siu, Albert L.
    AMERICAN JOURNAL OF PUBLIC HEALTH, 2007, 97 (12) : 2179 - 2185
  • [42] Health Care Spending and Use of Coronary Revascularization Procedures Among VA-Medicare Advantage Dual-Enrolled Veterans
    Dayoub, Elias J.
    Medvedeva, Elina L.
    Nathan, Ashwin
    Khatana, Sameed Ahmed M.
    Epstein, Andrew J.
    Groeneveld, Peter
    CIRCULATION, 2019, 140
  • [43] Compliance with mental health and other specialty care referrals among Medicare/Medicaid dual enrollees
    Mojtabai, R
    COMMUNITY MENTAL HEALTH JOURNAL, 2005, 41 (03) : 339 - 344
  • [44] Compliance with Mental Health and Other Specialty Care Referrals among Medicare/Medicaid Dual Enrollees
    Ramin Mojtabai
    Community Mental Health Journal, 2005, 41 : 339 - 344
  • [45] EFFECT OF TRANSFORMATION OF THE VETERANS AFFAIRS HEALTH CARE SYSTEM ON THE QUALITY OF HYPERTENSION CARE
    Brienza, Rebecca
    Anderson, Daren
    Goulet, Joseph L.
    Meyer, Emily M.
    Peixoto, Aldo
    JOURNAL OF GENERAL INTERNAL MEDICINE, 2012, 27 : S175 - S176
  • [46] Intensive Care Unit Admitting Patterns in the Veterans Affairs Health Care System
    Chen, Lena M.
    Render, Marta
    Sales, Anne
    Kennedy, Edward H.
    Wiitala, Wyndy
    Hofer, Timothy P.
    ARCHIVES OF INTERNAL MEDICINE, 2012, 172 (16) : 1220 - 1226
  • [47] Quality of ambulatory care for women and men in the veterans affairs health care system
    Jha, AK
    Perlin, JB
    Steinman, MA
    Peabody, JW
    Ayanian, JZ
    JOURNAL OF GENERAL INTERNAL MEDICINE, 2005, 20 (08) : 762 - 765
  • [48] Effect of the transformation of the Veterans Affairs health care system on the quality of care.
    Jha, AK
    Perlin, JB
    Kizer, KW
    Dudley, RA
    NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (22): : 2218 - 2227
  • [49] Utilization of Primary Care by Veterans with Psychiatric Illness in the National Department of Veterans Affairs Health Care System
    Chwastiak, Lydia A.
    Rosenheck, Robert A.
    Kazis, Lewis E.
    JOURNAL OF GENERAL INTERNAL MEDICINE, 2008, 23 (11) : 1835 - 1840
  • [50] Utilization of Primary Care by Veterans with Psychiatric Illness in the National Department of Veterans Affairs Health Care System
    Lydia A. Chwastiak
    Robert A. Rosenheck
    Lewis E. Kazis
    Journal of General Internal Medicine, 2008, 23 : 1835 - 1840