Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120

 

Presentation

Use of Primary Care in VA and Medicare among VAMC and CBOC Patients

Authors: Chuan-Fen Liu (VA Puget Sound Health Care System); Michael M Chapko (VA Puget Sound Health Care System); James F Burgess (VA Boston Health Care System); Christopher L Bryson (VA Puget Sound Health Care System); Mark Perkins (VA Puget Sound Health Care System); John C Fortney (VA Central Arkansas Healthcare System); Willard G Manning (University of Chicago); Nancy D Sharp (VA Puget Sound Health Care System); Matthew Maciejewski (Durham VA Medical Center)

Presenter: Chuan-Fen Liu (VA Puget Sound Health Care System)

Session: Poster Session

Room: Kirby Winter Garden

When: Monday 2:30 p.m. - 3:15 p.m.

Objectives: VA established community-based outpatient clinics (CBOCs) to improve veterans' access to primary care. Previous studies document lower primary care utilization in CBOC than VAMC patients. One possible explanation is that CBOC patients obtain more Medicare-covered primary care in the community. This study examines VA and Medicare primary care utilization among primary care patients in these settings.

Methods: This cohort study included 7,578 CBOC and 12,496 VAMC primary care users also eligible for Medicare based on age or disability, identified in FY2000. A primary care definition based on provider type and CPT codes was developed to compare VA and Medicare utilization using data from VA administrative databases and Medicare claims. Primary care use was classified into four groups for each year from 2001-2004: VA only, dual use (VA and Medicare), Medicare only, and no use.

Results: Overall, CBOC patients had fewer total primary care visits than VAMC patients each year (3.78 versus 4.12 in 2001) with fewer VA visits (2.11 versus 2.87 in 2001) but more Medicare visits (1.43 versus 0.96 in 2001). Among CBOC patients, the proportion of VA only primary care patients decreased (45.8% to 36.6%), dual use stayed stable (27.1%-29%), and Medicare only increased (11.1% to 17.9%) from 2001 to 2004. VAMC patients had similar trends, with a greater proportion of VA only (59.5%-50.8%) and smaller proportions of dual use (19.4%-20.5%) and Medicare only (6.7%-11.5%) compared to CBOC patients. Dual users in both CBOCs and VAMCs had more primary care visits than VA only and Medicare only groups, and used more Medicare than VA visits, with a trend toward fewer VA visits and more Medicare visits over time.

Conclusions: CBOC patients were more likely than VAMC patients to use primary care services in Medicare. The proportion of patients who used VA-only primary care decreased over time in both CBOC and VAMC cohorts. Increasing use of non-VA primary care services may affect continuity of care, chronic disease management, and provider- and system-level performance measures. These effects could be greater for CBOC patients. Development of strategies for sharing information between VA and non-VA primary care providers is critical to improving patient care.