# Are Veterans' Outcomes Better when VHA Purchases High-Quality Nursing Home Care?

> **NIH VA I01** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2020 · —

## Abstract

Background: Over the last decade, the Veterans' Health Administration (VHA) has shifted from providing
long-term and post-acute care in facilities owned and operated by states or the VHA, toward contracted care in
privately-owned facilities, known as community nursing homes (CNHs). From fiscal years 2000 to 2015,
expenditures for CNH care in the VHA expanded from $227 million to $861 million—nearly a fourfold increase.
Meanwhile, the Office of Inspector General and General Accountability Office have raised concerns that the
VHA contracts with low-quality providers. Through a Quality Enhancement Research Initiative (QUERI)-funded
CNH Dashboard, Veteran Affairs Medical Centers (VAMCs) now have ready access to real-time information
that displays data on the quality ratings of facilities caring for their Veterans relative to other, non-contracted
facilities in the same local market and nationally. However, those data have not been analyzed to reveal trends
or patterns across VAMCs that could inform VHA's purchasing policy and operations. Furthermore, the
publicly-reported quality star ratings from the Centers for Medicare and Medicaid Services (CMS) have not
been validated for their relevance to important Veterans' outcomes.
The objective of the proposed research is to characterize variation in CNH quality as it relates to VAMC
characteristics, Veteran outcomes, and contracting practices. Our central hypothesis is that a significant
portion of VAMCs have opportunities to improve practices related to the purchase of high-quality care for
Veterans that will lead to improved outcomes by optimizing identifiable contracting policies and practices. The
significance that motivates the proposed project is that identifying variation in quality, quantifying potential
gains, and understanding the policies associated with success within an integrated health care system will also
contribute to our general understanding of the use of quality information in purchasing policies and practices,
an HSR&D priority area of long-term care which is of broad concern to health services research in this era of
value based purchasing. The Specific Aims of this proposal are to:
Aim 1. Characterize utilization, cost, and quality of care that Veterans receive from VHA-contracted compared
to non-contracted community nursing homes (CNHs) available in the same market area.
Aim 2. Determine whether utilization of highly-rated CNHs improves outcomes for Veterans.
Aim 3. Identify incentive characteristics and contextual factors that contribute to purchase of high-quality CNH
care by VAMCs.
Methods: Aim 1 will use descriptive analysis to compare Veterans' utilization of nursing home care, including
length of stay, concentration of Veteran population within individual nursing homes, and allocation of care to
CNH compared to other VHA long-term care and post-acute settings in each study year 2013-2017. Risk-
adjusted total direct CNH payments per Veteran will be calculated and the relatio...

## Key facts

- **NIH application ID:** 9853626
- **Project number:** 5I01HX002529-02
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Cari Renee Levy
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9853626

## Citation

> US National Institutes of Health, RePORTER application 9853626, Are Veterans' Outcomes Better when VHA Purchases High-Quality Nursing Home Care? (5I01HX002529-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9853626. Licensed CC0.

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