OUTPATIENT SURGICAL UTILIZATION IN VETERANS-AFFAIRS-HOSPITALS, 1981-1989

In the 1980s, there was a large increase in the percentage of surgical operations performed in the United States without an overnight hospit al admission. This shift may have been related to changes in reimburse ment for outpatient surgery; studies of this relationship have had con flicting results. The Department of Veterans Affairs (VA) has a budget ing strategy significantly different from reimbursement strategies use d by nonfederal hospitals. The VA strategy underwent changes in terms of budgeting for outpatient surgery in the 1980s. Data from the Americ an Hospital Association (AHA) Annual Survey of Hospitals collected dur ing the years 1981 through 1989 inclusive were analyzed in an effort t o examine VA outpatient surgical utilization and to compare changes in VA outpatient surgical utilization with changes in outpatient surgica l utilization in the nonfederal sector. The VA had an apparent rapid e xpansion of outpatient surgical utilization in the mid-1980s compared with the nonfederal sector. This increase occurred without a concomita nt decrease in inpatient surgical procedures. This apparent rapid expa nsion may represent a combination of real changes in surgical utilizat ion, changes in utilization of services not traditionally thought to b e surgical but counted as such by VA hospitals, and changes in VA reco rd-keeping. All of the components of this expansion may have been acce lerated by the implementation of the VA Resource Allocation Methodolog y in 1985 and 1986.