- Costs and outcomes for coronary procedures vary depending on whether veterans are treated at Veterans Affairs hospitals or non-VA hospitals, but the reasons are somewhat elusive, a new study in JAMA Cardiology concludes.
- The researchers looked at 19,195 elective procedures between 2008 and 2011, comparing travel distance, 30-day mortality and costs. Nearly one in five procedures were performed at community-based hospitals under the VA Community Care Program, which allows veterans to seek care at non-VA hospitals and clinics when they face long wait times or a lack of specialists in the VA system.
- For the patients undergoing percutaneous coronary intervention (stent replacement) at a community hospital, travel distance was shorter but mortality and costs increased. Coronary artery bypass graft procedures in community hospitals were also associated with shorter travel distance, while mortality mirrored that of VA hospitals and costs were lower.
Thirty-day readmission rates for both types of procedures were similar for VA and non-VA hospitals.
“The higher mortality of CC-provided PCIs was not necessarily due to lower quality of care at CC hospitals,” the authors write. “Other possible factors include delay in making care arrangements, incomplete coordination of care between VA and CC hospitals, or failure to refill medications prescribed by CC clinicians. These are obvious areas for future research and quality improvement efforts.”
The study reaffirms earlier studies showing quality of VA care is similar to non-VA care. Since many VA hospitals are performing below recommended minimum annual procedure volumes, one way to improve veterans’ outcomes would be to increase capacity at high-performing VA hospitals rather than expand access at community facilities, the study says.
The study is relevant because the VA is considering expanding the outsourcing program as it works to reduce wait times. In October, the Denver VA Medical Center was forced to delay dozens of surgeries because of a shortage of anesthesiologists. The facility, part of the Eastern Colorado Health Care System, reportedly has among the worst wait times in the country.
As of July 2017, the average wait time for a primary care appointment at the Denver VA Medical Center was more than 18 days — triple that of the Phoenix VA facility where the problem was first uncovered in 2014.
The researchers noted several limitations to the study, including exclusion of patients 65 and older and potential changes in care patterns since the study period. They also did not analyze the impact of waiting times on outcomes.