Original ArticleVeterans Health Administration Patients’ Use of the Private Sector for Coronary Revascularization In New York Opportunities to Improve Outcomes by Directing Care to High-Performance HospitalsWeeks, William B. MD, MBA*†; Bott, David M. PhD‡; Bazos, Dorothy A. RN, PhD†; Campbell, Stacey L. MPH§; Lombardo, Rosemary MS¶; Racz, Michael J. PhD∥; Hannan, Edward L. PhD**; Wright, Steven M. PhD††; Fisher, Elliott S. MD, MPH*† Author Information From the *VA Outcomes Group, Veterans Health Administration, White River Junction, Vermont; †Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire; ‡Centers for Medicare and Medicaid Services, Baltimore, Maryland; §Office of Quality and Performance, VA Medical Center, Providence, Rhode Island; ¶University at Albany School of Public Health, Rensselaer, New York; ∥New York State Department of Health, School of Public Health, Rensselaer, New York; **Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, New York; ††Office of Quality and Performance, Veterans Health Administration, Washington, DC. Supported by VA Health Services Research and Development Grants ACC 01-117-1 and REA 03-098. Earlier versions of this work were presented at VHA's HSRD Annual Meeting in March 2004 (Washington, DC), at the AcademyHealth Annual Meeting in June, 2004 (San Francisco, CA), and at the International Health Economists’ Association Annual Meeting in July, 2005 (Barcelona, Spain). The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government. Reprints: William B. Weeks, MD, MBA, VAMC (11Q), WRJ, VT 05009. E-mail: [email protected] Medical Care: June 2006 - Volume 44 - Issue 6 - p 519-526 doi: 10.1097/01.mlr.0000215888.20004.5e Buy Metrics Abstract Objective: We sought to quantify Veterans Health Administration (VA) patients’ utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. Methods: Using VA and New York State administrative and clinical databases, we conducted a retrospective cohort study examining residents of New York State who were enrolled in the VA and underwent either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in 1999 or 2000 (n = 6562) in either the VA or the private sector. We first calculated the proportion of revascularizations obtained in the VA and the private sector. We then identified the private sector hospitals in which these men obtained revascularizations and determined potential changes in mortality and travel burden associated with directing private sector care to high performance hospitals. Results: VA patients in New York were much more likely to undergo revascularization in the private sector than in VA hospitals: 83% of CABGs (2341/2829) and 87% of PCIs (4054/4665) were obtained in the private sector. Private sector utilization was distributed evenly across high- and low-mortality hospitals. Directing private-sector CABG surgery to high-performance hospitals could have reduced expected mortality by 24% (from 2.3% to 1.7%) and would only increase median travel time from 21 to 30 minutes. The benefit of redirecting PCI care is minimal. Conclusions: For high-mortality procedures that veterans frequently obtain in the private sector, like CABG, directing care to high-performance hospitals may be an effective way to improve outcomes for veterans. © 2006 Lippincott Williams & Wilkins, Inc.