Utilization and Cost of Veterans Health Administration Referrals to Community Care-Based Physical Therapy

The Veterans Health Administration (VHA) provides health care in rural communities through the Telerehabilitation Enterprise-Wide Initiative (TR-EWI) and other community care (CC) programs. Telehealth may allow clinicians to overcome challenges associated with CC, but there is a lack of understanding of the use of CC for rehabilitation services.

This study explores CC physical therapy (PT) referral use and cost trends for 7 Veterans Integrated Services Networks (VISNs) with TR-EWI sites, using US Department of Veterans Affairs Corporate Data Warehouse and VHA Support Service Center referral data, as well as cost data from the VHA Community Care Referral Dashboard. We used descriptive statistics to analyze data. This study also qualitatively analyzed provisional diagnosis data to ascertain which PT diagnosis groups were most frequently referred to CC.

There were 344,406 PT referrals to CC from fiscal year (FY) 2019 to FY 2022. Referrals decreased from FY 2019 to FY 2020 but increased from FY 2020 to FY 2022, most notably in VISNs 19 and 22; VISN 8 consistently had high PT referrals over time. More referrals were made for veterans living in urban communities (56.2%) than rural communities (39.8%) and for those aged 60 to 69 years (20.7%) and aged 70 to 79 years (26.9%). There were 200,204 PT referrals with cost data from FY 2020 to FY 2022, totaling about $221 million in selected VISNs. Referral costs nearly doubled from FY 2020 to FY 2021, but only slightly increased from FY 2021 to FY 2022.

This study highlights the variations in PT referrals and costs across VISNs and eligibility reasons for CC referral. Cost trends underscore the financial commitment to provide PT to veterans. Understanding the factors driving cost is necessary for the VHA to optimally provide and manage the rehabilitation resources needed to serve veterans through traditional in-person care, telehealth, and CC while ensuring timely, high-quality care.