Veterans' Behavioral Health Hospitalizations and Outcomes in VA Versus Non‐ VA Hospitals

OBJECTIVE: To compare outcomes for Department of Veterans Affairs (VA) enrollees' behavioral health (BH) hospitalizations by source (VA-direct, VA-purchased community care (CC), Medicaid, Medicare, private insurance, and other payers). STUDY SETTING AND DESIGN: We conducted a retrospective, longitudinal study with VA enrollees from 2015 to 2017 to examine differences in BH hospitalization outcomes by source. We used generalized linear models with clustered standard errors to predict length of stay (LOS), cost, and 30-day readmission. DATA SOURCES AND ANALYTIC SAMPLE: We studied 124,609 BH hospitalizations of 77,299 VA enrollees in 11 geographically diverse states. PRINCIPAL FINDINGS: Predicted mean LOS (9.03 days, 95% CI 8.92-9.14 days; p < 0.001) and cost ($17,608, 95% CI $17,347-$17,870; p < 0.001) were highest for VA-direct hospitalizations, while the mean readmission rate was lowest for VA-direct hospitalizations (17.36%, 95% CI 17.03%-17.69%; p < 0.001). Average marginal effects for each non-VA hospitalization source were statistically significantly different from VA-direct hospitalizations (p < 0.001): between 2.13 and 2.90 days less for LOS, $11,141 to $12,144 less for cost, and 2.71% to 5.18% higher for readmission rate. CONCLUSIONS: The majority of BH hospitalizations were in VA-direct care (56%), with 44% provided in locations outside VA hospitals: Medicare (19%), CC (7%), private insurance (7%), other payers (6%), and Medicaid (5%). There are trade-offs between BH hospitalizations provided in VA-direct care (lowest readmission rate, highest LOS and costs) and other sources.