Elderly Veterans Receiving Care at a Veterans Affairs Medical Center While Enrolled in Medicare-Financed HMOs : Is the Taxpayer Paying Twice? |
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| Authors: | Leigh J Passman MD PhD Rosa Elena Garcia MPH Lynn Campbell BS Eric Winter RN PHN |
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| Institution: | (1) Division of General Internal Medicine, West Los Angeles, USA;(2) Medical Care Cost Recovery Program, West Los Angeles, USA;(3) Veterans Affairs Medical Center, and the University of California-Los Angeles School of Medicine, West Los Angeles, USA |
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| 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.
KEY WORDS: veterans; elderly; Medicare; HMOs; health care financing. |
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