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 hospital admission. This shift may have been related to changes in reimbursement for outpatient surgery; studies of this relationship have had conflicting results. The Department of Veterans Affairs (VA) has a budgeting strategy significantly different from reimbursement strategies used by nonfederal hospitals. The VA strategy underwent changes in terms of budgeting for outpatient surgery in the 1980s. Data from the American Hospital Association (AHA) Annual Survey of Hospitals collected during the years 1981 through 1989 inclusive were analyzed in an effort to examine VA outpatient surgical utilization and to compare changes in VA outpatient surgical utilization with changes in outpatient surgical utilization in the nonfederal sector. The VA had an apparent rapid expansion of outpatient surgical utilization in the mid-1980s compared with the nonfederal sector. This increase occurred without a concomitant decrease in inpatient surgical procedures. This apparent rapid expansion may represent a combination of real changes in surgical utilization, changes in utilization of services not traditionally thought to be surgical but counted as such by VA hospitals, and changes in VA record-keeping. All of the components of this expansion may have been accelerated by the implementation of the VA Resource Allocation Methodology in 1985 and 1986.