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S7: Plenary Session 7

SS19 - Procedure Mix and Regional Variation in Vascular Community Care Referrals in the Veterans Administration Health Care System

Saturday, June 17, 2023
9:12 AM – 9:23 AM ET
Objectives: The 2019 MISSION Act expanded access for Veterans to receive care in facilities outside the VA system. The effect of increasing Community Care Referrals (CCR) on vascular care for Veterans and its impact on the VA system remains unclear. We investigated the number, type, and cost of Vascular Surgery CCR, with the hypothesis that there could be variation in Vascular community care between VA regional networks and medical centers due to VA endovascular capabilities and regional differences in vascular care.

Methods: The VA Community Care Referral Dashboard and Integrated Informatics and Analytics from 2020-2022 were used to obtain number, cost, and paid claims for CPT codes related to Vascular Surgery CCRs from all 18 regional VISN’s and 140 VA Medical Centers. Referrals for “Vascular Surgery” were included, excluding “Vascular Testing” and “Dialysis Management.".

Results: Vascular Surgery CCR’s increased from 21,114 in 2020 to 41,986 in 2022 (98% increase) with an increased cost from $56,982,512 to $105,460,306 (85% increase). Although endovascular CPT codes made up just over half (58%) of the top 100 Paid Claims, the VA paid 5.4 times more for endovascular compared to open ($220,835,958 vs. $40,772,502), and endovascular procedures accounted for 85% of the Vascular Surgery CCR cost. Four atherectomy CPT codes (37227, 37225, 37229, 37231) accounted for 28.4% ($73,317,966) of the total cost of the top 100 CPT codes paid. Atherectomy procedure costs were unequally distributed among individual VA medical centers with 10 out of 140 centers (7.1%) accounting for 33.5% ($24,594,566) of the total atherectomy paid claims. The geographic distribution of these 10 centers was South (n=6); West (n=3); North (n=1); and East (n=0) and 8 of the 10 centers are located in regions with high atherectomy use rates. The facility complexity classification for the 10 centers was High (n=2); Medium (n=5); and Low (n=3), and only 2 of the 10 centers had a vascular surgeon listed on their medical staff.

Conclusions: In the last 3 years VA Vascular CCR’s have nearly doubled in number and cost. Endovascular procedures account for 85% of this cost, and over one-third of the cost involved atherectomy procedures. Of the 10 medical centers with the highest atherectomy payouts the majority were medium or low complexity, did not have vascular surgeon listed on staff, and were located in regions with high atherectomy use rate. These findings suggest that Vascular CCR may be influenced by VA endovascular resources and regional differences in vascular care.