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Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time

BACKGROUND: Through Community Care Networks (CCNs) implemented with the VA MISSION Act, VA expanded provider contracting and instituted network adequacy standards for Veterans’ community care. OBJECTIVE: To determine whether early CCN implementation impacted community primary care (PC) appointment w...

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Autores principales: Govier, Diana J., Hickok, Alex, Edwards, Samuel T., Weaver, Frances M., Gordon, Howard, Niederhausen, Meike, Hynes, Denise M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616400/
https://www.ncbi.nlm.nih.gov/pubmed/36307640
http://dx.doi.org/10.1007/s11606-022-07800-1
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author Govier, Diana J.
Hickok, Alex
Edwards, Samuel T.
Weaver, Frances M.
Gordon, Howard
Niederhausen, Meike
Hynes, Denise M.
author_facet Govier, Diana J.
Hickok, Alex
Edwards, Samuel T.
Weaver, Frances M.
Gordon, Howard
Niederhausen, Meike
Hynes, Denise M.
author_sort Govier, Diana J.
collection PubMed
description BACKGROUND: Through Community Care Networks (CCNs) implemented with the VA MISSION Act, VA expanded provider contracting and instituted network adequacy standards for Veterans’ community care. OBJECTIVE: To determine whether early CCN implementation impacted community primary care (PC) appointment wait times overall, and by rural/urban and PC shortage area (HPSA) status. DESIGN: Using VA administrative data from February 2019 through February 2020 and a difference-in-differences approach, we compared wait times before and after CCN implementation for appointments scheduled by VA facilities that did (CCN appointments) and did not (comparison appointments) implement CCNs. We ran regression models with all appointments, and stratified by rural/urban and PC HPSA status. All models adjusted for Veteran characteristics and VA facility–level clustering. APPOINTMENTS: 13,720 CCN and 40,638 comparison appointments. MAIN MEASURES: Wait time, measured as number of days from authorization to use community PC to a Veteran’s first corresponding appointment. KEY RESULTS: Overall, unadjusted wait times increased by 35.7 days ([34.4, 37.1] 95% CI) after CCN implementation. In adjusted analysis, comparison wait times increased on average 33.7 days ([26.3, 41.2] 95% CI, p < 0.001) after CCN implementation; there was no significant difference for CCN wait times (across-group mean difference: 5.4 days, [−3.8, 14.6] 95% CI, p = 0.25). In stratified analyses, comparison wait time increases ranged from 29.6 days ([20.8, 38.4] 95% CI, p < 0.001) to 42.1 days ([32.9, 51.3] 95% CI, p > 0.001) after CCN implementation, while additional differences for CCN appointments ranged from 13.4 days ([3.5, 23.4] 95% CI, p = 0.008) to −15.1 days ([−30.1, −0.1] 95% CI, p = 0.05) for urban and PC HPSA appointments, respectively. CONCLUSIONS: After early CCN implementation, community PC wait times increased sharply at VA facilities that did and did not implement CCNs, regardless of rural/urban or PC HPSA status, suggesting community care demand likely overwhelmed VA resources such that CCNs had limited impact. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07800-1.
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spelling pubmed-96164002022-10-31 Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time Govier, Diana J. Hickok, Alex Edwards, Samuel T. Weaver, Frances M. Gordon, Howard Niederhausen, Meike Hynes, Denise M. J Gen Intern Med Original Research BACKGROUND: Through Community Care Networks (CCNs) implemented with the VA MISSION Act, VA expanded provider contracting and instituted network adequacy standards for Veterans’ community care. OBJECTIVE: To determine whether early CCN implementation impacted community primary care (PC) appointment wait times overall, and by rural/urban and PC shortage area (HPSA) status. DESIGN: Using VA administrative data from February 2019 through February 2020 and a difference-in-differences approach, we compared wait times before and after CCN implementation for appointments scheduled by VA facilities that did (CCN appointments) and did not (comparison appointments) implement CCNs. We ran regression models with all appointments, and stratified by rural/urban and PC HPSA status. All models adjusted for Veteran characteristics and VA facility–level clustering. APPOINTMENTS: 13,720 CCN and 40,638 comparison appointments. MAIN MEASURES: Wait time, measured as number of days from authorization to use community PC to a Veteran’s first corresponding appointment. KEY RESULTS: Overall, unadjusted wait times increased by 35.7 days ([34.4, 37.1] 95% CI) after CCN implementation. In adjusted analysis, comparison wait times increased on average 33.7 days ([26.3, 41.2] 95% CI, p < 0.001) after CCN implementation; there was no significant difference for CCN wait times (across-group mean difference: 5.4 days, [−3.8, 14.6] 95% CI, p = 0.25). In stratified analyses, comparison wait time increases ranged from 29.6 days ([20.8, 38.4] 95% CI, p < 0.001) to 42.1 days ([32.9, 51.3] 95% CI, p > 0.001) after CCN implementation, while additional differences for CCN appointments ranged from 13.4 days ([3.5, 23.4] 95% CI, p = 0.008) to −15.1 days ([−30.1, −0.1] 95% CI, p = 0.05) for urban and PC HPSA appointments, respectively. CONCLUSIONS: After early CCN implementation, community PC wait times increased sharply at VA facilities that did and did not implement CCNs, regardless of rural/urban or PC HPSA status, suggesting community care demand likely overwhelmed VA resources such that CCNs had limited impact. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07800-1. Springer International Publishing 2022-10-28 2023-03 /pmc/articles/PMC9616400/ /pubmed/36307640 http://dx.doi.org/10.1007/s11606-022-07800-1 Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Research
Govier, Diana J.
Hickok, Alex
Edwards, Samuel T.
Weaver, Frances M.
Gordon, Howard
Niederhausen, Meike
Hynes, Denise M.
Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time
title Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time
title_full Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time
title_fullStr Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time
title_full_unstemmed Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time
title_short Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time
title_sort early impact of va mission act implementation on primary care appointment wait time
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616400/
https://www.ncbi.nlm.nih.gov/pubmed/36307640
http://dx.doi.org/10.1007/s11606-022-07800-1
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