Duplicate federal payments for dual enrollees in Medicare Advantage plans and the Veterans Affairs health care system.
Duplicate federal payments for dual enrollees in Medicare Advantage plans and the Veterans Affairs health care system.
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为 Medicare Advantage 计划和退伍军人事务部医疗保健系统的双重参保者重复联邦付款。
DOI：
10.1001/jama.2012.7115
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发表时间：
2012-07-04
期刊：
影响因子：
--
通讯作者：
Kizer KW
中科院分区：
文献类型：
--
作者：
Trivedi AN;Grebla RC;Jiang L;Yoon J;Mor V;Kizer KW
一些退伍军人有资格同时参加医疗保险优势（MA）计划和退伍军人事务部医疗保健系统（VA）。这种情况产生了多余的联邦支出的可能性，因为MA计划将收到付款，以确保退伍军人谁接受照顾从退伍军人事务部，另一个纳税人资助的健康计划。量化VA和MA双入组的患病率，在每种情况下同时使用卫生服务，以及为MA入组者提供VA护理的估计成本。回顾性分析了2004-2009年期间同时参加VA和MA计划的1 245 657名退伍军人。卫生服务的使用和通货膨胀调整后的VA医疗保健费用估计。在有资格参加退伍军人管理局和医疗补助计划的个人中，双重参加的人数从2004年的485 651人增加到2009年的924 792人。2009年，8.3%的医疗补助人口加入了退伍军人管理局，5.0%的医疗补助受益人是退伍军人管理局的使用者。MA注册者的VA医疗保健费用估计在6年内总计130亿美元，从2004年的13亿美元增加到2009年的32亿美元。在双重登记者中，10%专门使用VA进行门诊和急性住院服务，35%专门使用MA计划，50%同时使用VA和MA，4%在日历年内没有接受任何服务。VA资助了该双重入组人群所有门诊访视的44%（n=21 353 841）、所有急性内科和外科住院的15%（n=177 663）和所有急性内科和外科住院天数的18%（n=1 106 284）。2009年，退伍军人事务部向私人保险公司收取了5230万美元的费用，用于偿还向MA登记者提供的护理，并收取了940万美元（占账单金额的18%;占护理总成本的0.3%）。联邦政府在2个独立的管理式护理计划中花费了大量且不断增加的潜在重复资金，用于护理相同的个人。
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. 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. Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004–2009. Use of health services and inflation-adjusted estimated VA health care costs. 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 totaled $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). 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.