title: Elderly veterans receiving care at a Veterans Affairs Medical Center while enrolled in Medicare-financed HMOs. Is the taxpayer paying twice?
abstract: Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, 337 involved elderly veterans. Of these 337 hospitalizations, 218 (65%) were for 174 veterans who stated they were enrolled in a Medicare-financed HMO. The VA's Medical Care Cost Recovery Program deemed only 46 (21%) of the hospitalizations billable and received reimbursement for 20 (9%). Thus, the VA is providing costly services already paid for by the Health Care Financing Administration under prepaid capitation contracts, and recovers minimal reimbursement from the HMOs.
authors.affiliation: Division of General Internal Medicine, West Los Angeles Veterans Affairs Medical Center, CA 90073, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Passman
authors.forename: R E
authors.initials: RE
authors.lastname: Garcia
authors.forename: L
authors.initials: L
authors.lastname: Campbell
authors.forename: E
authors.initials: E
authors.lastname: Winter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002204:Capitation Fee; D005260:Female; D017048:Health Care Costs / Q000592:standards / Q000639:trends; D006279:Health Maintenance Organizations / Q000191:economics* / Q000639:trends; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D007350:Insurance, Hospitalization / Q000191:economics* / Q000639:trends; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data* / Q000639:trends; D012051:Reimbursement Mechanisms; D014481:United States; D014728:Veterans