Comorbidity Assessment Is Uneven Across Veterans Health Administration and Medicare for the Same Patient: Implications for Risk Adjustment. Issue 8 (August 2020)

• Record Type: Journal Article
• Authors: Gidwani-Marszowski, Risha; Boothroyd, Derek; Needleman, Jack; Illarmo, Samantha; Asch, Steven M.
• Is Part Of: Medical care. Volume 58:Issue 8(2020)
• Publication Date: 2020-08
• Subjects: risk adjustment -- Veterans -- Medicare -- comorbidities -- administrative data; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001329
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Objective: Compare comorbidity identification in Medicare and Veterans Health Administration (VA) data for the purposes of risk adjustment. Data Sources: Analysis of Medicare and VA datasets for dually-enrolled Veterans receiving care in both settings, fiscal years 2010–2014. Study Design: A retrospective analysis of administrative data for a national sample of cancer decedents. Data Extraction Methods: Comorbidities were evaluated using Elixhauser and Charlson coding algorithms. Principal Findings: Clinical comorbidities were more likely to be recorded in Medicare than in VA datasets. Of 42 comorbidities, 36 (86%) were recorded at a different frequency. For example, congestive heart failure was recorded for 22.0% of patients in Medicare data and for 11.3% of patients in VA data ( P <0.001). Conclusion: There are large differences in comorbidity assessment across VA and Medicare administrative data for the same patient, posing challenges for risk adjustment.