title: Patient and Facility Variation in Costs of VA Heart Failure Patients.
abstract: This study sought to determine the variation in annual health care costs among patients with heart failure in the Veterans Affairs (VA) system.
  
  
  
  Heart failure is associated with considerable use of health care resources, but little is known about patterns in patient characteristics related to higher costs.
  
  
  
  We obtained VA utilization and cost records for all patients with a diagnosis of heart failure in fiscal year 2010. We compared total VA costs by patient demographic factors, comorbid conditions, and facility where they were treated in bivariate analyses. We regressed total costs on patient factors alone, VA facility alone, and all factors combined to determine the relative contribution of patient factors and facility to explaining cost differences.
  
  
  
  There were 117,870 patients with heart failure, and their mean annual VA costs were $30,719 (SD 49,180) with more than one-half of their costs from inpatient care. Patients at younger ages, of Hispanic or black race/ethnicity, diagnosed with comorbid drug use disorders, or who died during the year had the highest costs (all p < 0.01). There was variation in costs by facility as mean adjusted costs ranged from approximately $15,000 to $48,000. In adjusted analyses, patient factors alone explained more of the variation in health care costs (R(2) = 0.116) compared with the facility where the patient was treated (R(2) = 0.018).
  
  
  
  A large variation in costs of heart failure patients was observed across facilities, although this was explained largely by patient factors. Improving the efficiency of VA resource utilization may require increased scrutiny of high-cost patients to determine if adequate value is being delivered to those patients.
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California. Electronic address: jean.yoon@va.gov.
authors.forename: Jean
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld
authors.affiliation: Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.
authors.forename: Anju
authors.initials: A
authors.lastname: Sahay
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Stanford University School of Medicine, Stanford, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006268:Health Facilities / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology; D006630:Hispanic or Latino; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D009026:Mortality; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics*
keywords: costs; heart failure; veterans