Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration.
Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration.
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估计退伍军人卫生管理局在社区购买的手术护理费用。
DOI：
10.1177/23814683211057902
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发表时间：
2021-07
影响因子：
--
通讯作者：
Rosen AK
中科院分区：
文献类型：
--
作者：
Wagner TH;Lo J;Beilstein-Wedel E;Vanneman ME;Shwartz M;Rosen AK
背景退伍军人获得退伍军人事务部（VA）购买的社区护理扩大由于在2014年退伍军人选择法提供的资金大幅增加。目标.比较VA提供的护理和VA支付的两种常用手术（全膝关节置换术（TKA）和白内障手术）的购买护理费用。研究设计。描述性统计和回归分析检查VA提供和VA购买的护理成本（2018财年[2017年10月至2018年9月]）。科目总计13，718例TKA，其中6，293例（46%）在VA中进行。共进行了91，659例白内障手术，其中65，799例（72%）在VA中进行。措施VA提供的护理的成本基于活动的成本估计; VA购买的护理的成本基于批准和支付的索赔。结果98%的VA提供的TKA发生在住院医院，平均费用为28，969美元（SD $10，778）。大部分（86%）VA购买的TKA也是在住院医院进行的，平均付款为13，339美元（SD $23，698）。VA提供的白内障手术在医院作为门诊手术进行，平均费用为4，301美元（SD $2，835）。VA购买的白内障手术在医院进行的平均$1，585（SD $629）;那些在门诊手术中心进行的平均成本为$1，346（SD $463）。我们还发现，使用VA提供的护理的患者的Nosos风险评分显著高于VA购买的护理。结论. VA提供的护理费用高于VA购买的护理费用，但这部分反映了立法上限限制VA向社区提供者支付医疗保险金额。VA中较高的患者风险评分可能表明社区提供者不愿意接受高风险患者，因为医疗保险报销，或者VA提供者更愿意将更复杂的患者留在VA中。
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.
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影响因子：
3.5
作者：
Gruber, Jonathan;Simon, Kosali
通讯作者：
Simon, Kosali
影响因子：
3.4
作者：
Nelson, Richard E.;Suo, Ying;Gundlapalli, Adi V.
通讯作者：
Gundlapalli, Adi V.
影响因子：
4.6
作者：
Shroyer, A. Laurie W.;Quin, Jacquelyn A.;Hattler, Brack
通讯作者：
Hattler, Brack
影响因子：
2.5
作者：
Carey, Kathleen;Stefos, Theodore;Rosen, Amy K.
通讯作者：
Rosen, Amy K.
DOI：
10.5435/jaaos-d-19-00775
发表时间：
2020-11-15
影响因子：
3.2
作者：
Frisch, Nicholas B.;Courtney, P. Maxwell;Gerlinger, Tad L.
通讯作者：
Gerlinger, Tad L.