Do Financial Incentives Lead to More Medicare Interventions?
By Brenda L. Mooney
PALO ALTO, CA—VA patients dying of cancer are far less likely to receive excessive and unnecessary end-of-life interventions than those treated by Medicare.
In a report published in the journal Health Affairs, study authors warned that pushing for VA to become more of a purchaser than provider of medical services could mean lower quality care in situations such as this.1
“The findings are not just important for veterans and VA policy, but for anybody who needs medical care at the end of life, which is a majority of us,” said Risha Gidwani-Marszowski, DrPH, a health economist at the VA Health Economics Resource Center at the Palo Alto VAMC and a consulting assistant professor of medicine at Stanford University. “We as a society need to ensure we are setting up the organization of healthcare and its financial incentives to ensure that the services patients receive are the ones that are in their best interests at the end of life.”
Study authors also sounded a warning about changes in VA promoted by some congressional and VA leaders. “Fee-for-service Medicare provides an example of how purchased care differs from the VA’s directly provided care,” they noted. “Using established indicators of overly intensive end-of-life care, we compared the quality of care provided through the two systems to veterans dying of cancer in fiscal years 2010–14. The Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital and death in the hospital.”
On the other hand, researchers pointed out, the VA patients were more likely to have multiple emergency department visits.
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