Comparing cataract surgery complication rates in veterans receiving VA and community care

Abstract

Objectives: To compare 90-day postoperative complication rates between Veterans receiving cataract surgery in VA vs Community Care (CC) during the first year of implementation of the Veterans Choice Act. Data Sources: Fiscal Year (FY) 2015 VA and CC outpatient data from VA's Corporate Data Warehouse (CDW) 10/01/14-9/30/15). FY14 data were used to obtain baseline clinical information prior to surgery. Study Design: Retrospective one-year study using secondary data to compare 90day complication rates following cataract surgery (measured using National Quality Forum (NQF) criteria) in VA vs CC. NQF defines major complications from a specified list of Current Procedural Terminology (CPT) codes. We ran a series of logistic regression models to predict 90-day complication rates, adjusting for Veterans' sociodemographic characteristics, comorbidities, preoperative ocular conditions, eye risk group, and type of cataract surgery (classified as routine vs complex). Data Collection: We linked VA and CC users through patient identifiers obtained from the CDW files. Our sample included all enrolled Veterans who received outpatient cataract surgery either in the VA or through CC during FY15. Cataract surgeries were identified through CPT codes 66 984 (routine) and 66 982 (complex).

Estimating the Cost of Surgical Care Purchased in the Community by the Veterans Health Administration

“…The VA Office of Community Care also developed partnerships with third-party administrators to create networks of community providers willing to treat veterans. Although there has been some research on quality of care and patient experience, 16,[27][28][29] there has been little research on costs and none on value of care, in part because this required gaining experience with VA's new claims database (PIT).…”

“…15 For cataracts, we also followed CMS methodology to identify complex (CPT code 66982) and routine (66984) surgeries, respectively (including the eye modifiers). 16 For VA-purchased care, we included claims that were listed as current and accepted claims that were paid using Choice Act funds. These restrictions were recommended by the VA Office of Community Care to remove unpaid or rejected claims.…”

Comparing Driving Miles for Department of Veterans Affairs–delivered Versus Department of Veterans Affairs–purchased Cataract Surgery

“…(Additional descriptive details of our study cohort have been published elsewhere. 10 ) We included only one surgery per eye per Veteran in our cohort, and each surgery formed the unit of analysis (rather than the Veteran) as it was exceptionally rare for Veterans (103 total) to have surgery on both eyes during a single day; in the case of multiple surgeries per eye, we included only the first surgery in FY2015 for each eye (1 right and 1 left).…”

Partnership Forum

“…To address this gap, we presented our research comparing 90-day postoperative complication rates of cataract surgery between VA and Community Care. 19 We selected cataract surgery for the comparison because: (1) 90-day complication is a nationally endorsed outcome measure widely used in the United States; (2) it is a common procedure in the VA and US, with surgery rates increasing as the population ages; and (3) it is a well-defined, high-frequency procedure. Although we hypothesized that Veterans going to Community Care would have higher complication rates than those getting their cataract surgery in the VA due to the potential for fragmented care, this hypothesis was not supported by the data.…”