Determinants of referral network size for screening colonoscopies in the Veterans Health Administration after the implementation of the MISSION Act

Author:

Eck Chase S.123ORCID,Ho Vivian345ORCID,Jiang Cheng123,Petersen Laura A.123

Affiliation:

1. Michael E. DeBakey VA Medical Center Houston Texas USA

2. Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) Houston Texas USA

3. Section of Health Services Research, Department of Medicine Baylor College of Medicine Houston Texas USA

4. Department of Economics Rice University Houston Texas USA

5. Baker Institute for Public Policy Rice University Houston Texas USA

Abstract

AbstractObjectiveTo measure key characteristics of the Veterans Health Administration's (VHA) Community Care (CC) referral network for screening colonoscopy and identify market and institutional factors associated with network size.Data SourcesVHA electronic health records, CC claim data, and National Plan and Provider Enumeration System.Study DesignIn this retrospective cross‐sectional study, we measure the size of the VHA's CC referral networks over time and by VHA parent facility (n = 137). We used a multivariable linear regression to identify factors associated with network size at the market‐year level. Network size was measured as the number of physicians who performed at least one VHA‐purchased screening colonoscopy per 1000 enrollees at baseline.Data ExtractionData were extracted for all Veterans (n = 102,119) who underwent a screening colonoscopy purchased by the VHA from a non‐VHA physician from 2018 to 2021.Principal FindingsFrom 2018 to 2021, median network volume of screening colonoscopies per 1000 enrollees grew from 1.6 (IQR: 0.6, 4.6) to 3.6 (IQR: 1.6, 6.6). The median network size grew from 0.63 (IQR: 0.30, 1.26) to 0.92 (IQR: 0.57, 1.63). Finally, the median procedures per physician increased from 2.5 (IQR: 1.6, 4.2) to 3.2 (IQR: 2.4, 4.7). After adjusting for baseline market characteristics, volume of screening colonoscopies was positively related to network size (β = 0.15, 95% CI: [0.10, 0.20]), negatively related to procedures per physician (β = −0.12, 95% CI: [−0.18, −0.05]), and positively associated with the percent of rural enrollees (β = 0.01, 95% CI: [0.00, 0.01]).ConclusionsVHA facilities with a higher volume of VHA‐purchased screening colonoscopies and more rural enrollees had more non‐VHA physicians providing care. Geographic variation in referral networks may also explain differences in the effects of the MISSION Act on access to care and patient outcomes.

Funder

Office of Research and Development

Publisher

Wiley

Subject

Health Policy

Reference45 articles.

1. IsaksonJ.S.2372 ‐ 115th Congress (2017–2018): VA MISSION Act of 2018.2018. Accessed November 10 2022http://www.congress.gov/

2. RogersH.H.R.3230 ‐ 113th Congress (2013–2014): Veterans Access Choice and Accountability Act of 2014.2014. Accessed November 10 2022http://www.congress.gov/

3. Innovations in Community Care Programs, Policies, and Research

4. Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers

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