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Title

Quality of End-Of-Life Care Is Higher in the VA Compared to Care Paid for by Traditional Medicare (Health Affairs)

Publication Topics

Access to Health Care; Family, Caregiving and Parental Issues; Elderly; Low-Income; Persons with Disabilities; Uninsured; Health Care Economics; Cost and Utilization Studies; Costs of Specific Medical and Public Health Interventions; Health Insurance Coverage and Programs; Managed Care; Medicare

Publication Type

Journal Article

Publication Date

2018-01-23T08:00:00Z

Author 1

<a onclick="OpenPopUpPage('http://healthpolicy.ucla.edu/_layouts/listform.aspx?PageType=4&ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=1515&RootFolder=*', RefreshPage); return false;" href="http://healthpolicy.ucla.edu/_layouts/listform.aspx?PageType=4&ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=1515&RootFolder=*">Risha Gidwani-Marszowski</a>

Author 2

<a onclick="OpenPopUpPage('http://healthpolicy.ucla.edu/_layouts/listform.aspx?PageType=4&ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=627&RootFolder=*', RefreshPage); return false;" href="http://healthpolicy.ucla.edu/_layouts/listform.aspx?PageType=4&ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=627&RootFolder=*">Jack Needleman, PhD</a>

Author 3

<a onclick="OpenPopUpPage('http://healthpolicy.ucla.edu/_layouts/listform.aspx?PageType=4&ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=151&RootFolder=*', RefreshPage); return false;" href="http://healthpolicy.ucla.edu/_layouts/listform.aspx?PageType=4&ListId={7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=151&RootFolder=*">et al</a>

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Abstract

Congressional and Veterans Affairs (VA) leaders have recommended the VA become more of a purchaser than a provider of health care. Fee-for-service Medicare provides an example of how purchased care differs from the VA's directly provided care. Using established indicators of overly intensive end-of-life care, authors compared the quality of care provided through the two systems to veterans dying of cancer in fiscal years 2010–14.

The Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital, and death in the hospital. However, they were significantly less likely than VA-reliant patients to have multiple emergency department visits. Higher-intensity, end-of-life care may be driven by financial incentives present in fee-for-service Medicare but not in the VA's integrated system. To avoid putting VA-reliant veterans at risk of receiving lower-quality care, VA care-purchasing programs should develop coordination and quality monitoring programs to guard against overly intensive end-of-life care.

The study was supported by the Department of Veterans Affairs (VA) Health Services Research and Development Program.

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Journal Article: Quality of End-Of-Life Care Is Higher in the VA Compared to Care Paid for by Traditional Medicare

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Version: 2.0
Created at 1/29/2018 7:38 AM by i:0#.f|uclachissqlmembershipprovider|celeste
Last modified at 1/29/2018 7:39 AM by i:0#.f|uclachissqlmembershipprovider|celeste