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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Katherine S. Virgo, PhD, MBA1, Lucille C. Dauz, MA2, Lan H. Marietta, MA2, Lesley A. Clarke2, Walter E. Longo, MD1, and Frank E. Johnson, MD1. (1) Department of Surgery, St. Louis University & Department of Veterans Affairs Medical Center, 3635 Vista at Grand Blvd, St. Louis, MO 63110-0250, (314) 289-7023, virgoks@slu.edu, (2) Department of Veterans Affairs Medical Center, 915 N. Grand (151JC), Saint Louis, MO 63106
The objective was to analyze patterns of health services utilization after diagnosis among veterans with colorectal cancer and differentiate patients with a sole source of care (Department of Veterans Affairs (VA) or Medicare-reimbursed) from those with dual sources of care (VA and Medicare-reimbursed). It was hypothesized that a substantial number of VA patients with colorectal cancer were dual users for whom continuity of care could be substantially improved if all care were provided through a single health care system. Thirteen years of nationwide Medicare and VA inpatient and outpatient data were retrospectively analyzed beginning with the three years pre-diagnosis (1986-1990) through a minimum of five years post-diagnosis (1994-1998) to examine patterns of health services utilization. Data were also extracted from tumor registry files, Computerized Patient Record System Files, and paper medical records at each VA. All VA patients who were diagnosed with colorectal cancer and surgically treated for cure during the 5-year period 1989-1993, were Medicare-eligible at diagnosis, and survived the index admission were considered eligible. Using conservative definitions of relevant CPT codes and defining baseline as the admission when the initial tumor was treated, inpatient dual users constituted slightly less than 15 percent of the 6612 veterans diagnosed with and surgically treated for colorectal cancer. Using a broader definition of relevant CPT codes and defining baseline as first visit or admission at which colorectal cancer was evaluated, increased inpatient dual users to approximately 32 percent of the population and outpatient dual users to 41 percent of the population. Examining inpatient and outpatient utilization in chronological order in a single file, increased dual users to 56.5 percent of the population. Use of multiple systems of care is prevalent among veterans with colorectal cancer. Continuity of care could be improved if all care could be provided through a single health care system. The types of services utilized when patients switch from one source of care to another are currently under analysis as are models attempting to identify predictors of utilization for this population. This study is of particular interest to the Department of Veterans Affairs since individual VA facilities are now able to retain Medical Care Cost Recovery dollars collected from private insurance plans and may soon be able to keep dollars collected from Medicare. Real health care dollars are lost when patients cross over to other health care systems. Primary Funding Source: Department of Veterans Affairs Heartland Network
Learning Objectives: At the conclusion of this session, the participant will be able to
Keywords: Health Care Utilization, Medicare
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.