scholarly journals Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD

2020 ◽  
Vol 15 (11) ◽  
pp. 1631-1639
Author(s):  
Virginia Wang ◽  
Shailender Swaminathan ◽  
Emily A. Corneau ◽  
Matthew L. Maciejewski ◽  
Amal N. Trivedi ◽  
...  
Keyword(s):  
Access To Care ◽  
Veterans Affairs ◽  
Dialysis Access ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Payment Reform ◽  
Community Based ◽  
Time Period ◽  
Community Providers ◽  
Dialysis Facilities

Background and objectivesBecause of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011—when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care—payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans’ access to dialysis care and mortality.Design, setting, participants, & measurementsAn interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA–financed dialysis in community-based dialysis facilities before (2006–2008), during (2009–2010), and after the enactment of VA policies to standardize dialysis payments (2011–2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans’ distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period.ResultsBefore payment reform, the unadjusted average per-treatment reimbursement for non–VA dialysis care varied widely ($47–$1575). After payment reform, there was a 44% reduction ($44–$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73–$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%).ConclusionsVA policies to standardize payment and establish national dialysis contracts increased the value of VA–financed community dialysis care by reducing reimbursement without compromising access to care or survival.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Jonathan B. Perlin
Keyword(s):  
United States ◽  
Health Care ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Affairs ◽  
United States Department ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

scholarly journals The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations

2021 ◽  
Author(s):  
Matthew Vincenti ◽  
Anthony Albanese ◽  
Edward Bope ◽  
Bradley V. Watts
Keyword(s):  
Rural Areas ◽  
Psychiatry Residency ◽  
Regional Distribution ◽  
Geographic Location ◽  
Veterans Affairs ◽  
Psychiatric Residency ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Rural Patient

Abstract Objective The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality. Methods The authors collected data on psychiatry residency positions from the Veterans Affairs’ Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served. Results Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions. Conclusions While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.

Logistic analysis of veterans' eligibility-status changes

2005 ◽  
Vol 18 (3) ◽  
pp. 175-185 ◽  
Author(s):  
Jian Gao ◽  
Ying Wang ◽  
Joseph Engelhardt
Keyword(s):  
Health Care ◽  
Economic Status ◽  
Veterans Affairs ◽  
Limited Resources ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Logistic Analysis ◽  
The Us ◽  
Regression Techniques ◽  
Increasing Demand

Currently, the US Department of Veterans Affairs provides medical care to more than four million veterans across the nation. Given the limited resources and increasing demand, the US Department of Veterans Affairs Health Administration (VA) is required by law to ensure that veterans with similar economic status and eligibility priority have similar access to VA health care, regardless of where they reside. This study, using descriptive statistics and logistic regression techniques, examines the factors that affect veterans' eligibility-status changes. This study found that veterans' demographics are correlated with the likelihood of eligibility-status conversion. More importantly, this study concludes that eligibility-status changes have a geographic pattern. These findings are important and useful in planning workload, as well as improving equal access of health care.

Evaluation of the Department of Veterans Affairs Community-Based Outpatient Clinics

Medical Care ◽  
2002 ◽  
Vol 40 (7) ◽  
pp. 555-560 ◽  
Author(s):  
Michael K. Chapko ◽  
Steven J. Borowsky ◽  
John C. Fortney ◽  
Ashley N. Hedeen ◽  
Marsha Hoegle ◽  
...  
Keyword(s):  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Department Of Veterans Affairs ◽  
Community Based

scholarly journals Legionella in the veterans healthcare system: report of an eight-year survey

2003 ◽  
Vol 131 (2) ◽  
pp. 835-839 ◽  
Author(s):  
A. A. KELLY ◽  
L. H. DANKO ◽  
S. M. KRALOVIC ◽  
L. A. SIMBARTL ◽  
G. A. ROSELLE
Keyword(s):  
Healthcare System ◽  
Positive Outcome ◽  
The United States ◽  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Fiscal Year ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Healthcare Associated

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3·62 million persons were served by the VHA. From fiscal year 1989–1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992–1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95·5% respectively (P=0·005 and 0·01). Case rates also decreased significantly for community and healthcare-associated cases (P=0·02 and 0·001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P=0·02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P=0·02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.

scholarly journals 493. Laboratory Evaluation and Epidemiology of Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae in Department of Veterans Affairs, 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S240-S241
Author(s):  
Christopher Pfeiffer ◽  
Holly B Williams ◽  
Hannah Flegal ◽  
J Stacey Klutts ◽  
Martin Evans ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Veterans Affairs ◽  
Screening Tests ◽  
Laboratory Evaluation ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Case Definitions ◽  
Carbapenem Resistant ◽  
And Control ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenemase-producing (CP)-carbapenem-resistant Enterobacteriaceae (CRE) pose a major threat to public health and are a priority target of national prevention and control efforts including within Department of Veterans Affairs (VA). The laboratory evaluation and epidemiology of CRE in VA is uncertain. Methods Using data from the Veterans Health Administration Corporate Data Warehouse, we identified all Veterans with ≥1 CRE result obtained during 2017 and reviewed their electronic health record. Two case definitions were used: (1) 2015 CDC CRE (Enterobacteriaceae resistant to any carbapenem or with documented carbapenemase production) and (2) 2017 VA CP-CRE (E. coli, Klebsiella spp., and Enterobacter spp. resistant to imipenem, meropenem, or doripenem or with documented carbapenemase production). Patients harboring carbapenemase-producers detected by rectal screening tests only were included. We reviewed patient charts whose isolates met both CRE definitions, extracting detailed microbiologic and travel data for the first positive 2017 result. Results We identified 904 unique Veterans with CRE; 577 (64%) patients had results meeting both CRE case definitions while 327 (36%) had results meeting CDC CRE criteria only (Figure 1). Of the 458 patients with clinical isolates meeting both case definitions, urine specimens predominated (64%) and were associated with the lowest crude 90-day mortality (16%); mortality was highest amongst patients with respiratory tract cultures (40%) and bloodstream isolates (34%) (Figure 2). Nearly half (48%) of VA CP-CRE were tested for carbapenemases (76% in-house; 24% send-out); of these, 75%tested positive with 78% being a KPC, 1% NDM, and 21% unspecified (Figure 3). Additionally, all 119 CRE carriers with an identified gene had KPC. Only 7 patients (1%) had documented overseas travel. Conclusion Currently the incidence of CP-CRE in the nation’s largest healthcare system is low relative to other problem pathogens such as MRSA and Clostridioides difficile but is associated with a high crude mortality especially with respiratory and bloodstream isolates. KPC comprised almost all carbapenemases identified. This provides an initial, granular snapshot of CRE in VA to serve as a roadmap for ongoing CP-CRE prevention and control. Disclosures All authors: No reported disclosures.

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