Veterans Affairs Community Care vascular surgery procedural costs from 2020 to 2025 dominated by infrainguinal endovascular interventions.

Abstract

Objective: The 2018 MISSION Act for expanding access for Veterans to receive care outside the Veterans Affairs (VA) health care system has resulted in a significant increase in vascular surgery Community Care referrals and cost, especially for endovascular procedures, over time. We hypothesized that more endovascular procedures would be performed over time and that this would contribute to increasing costs over the study period.

Methods: A retrospective analysis of the VA Community Care Referral Dashboard and Integrated Informatics and Analytics was conducted for fiscal year (FY) 2020 to FY 2025. Referral volume and justification for vascular surgery consultation and vascular laboratory, and total paid claims were obtained for 40 vascular surgery-related current procedural terminology codes from all VA centers nationwide across four categories: endovascular arterial, open arterial, dialysis access, and vein procedures. All costs were inflation-adjusted to 2025 U.S. dollars using the Consumer Price Index.

Results: Total vascular surgery Community Care paid claims increased from $72.7 million in FY 2020 to $288.2 million in FY 2025 (+296%). Number of referrals rose from 34,196 in FY 2021 to 62,487 in FY 2025 (+83%). Distance from a VA facility accounted for more than 70% of referral justifications. Endovascular arterial procedures represented the largest cost annually. Femoral-popliteal atherectomy (current procedural terminology [CPT] code 37225) was the highest-cost procedure in all years except 2022, with increasing cost from $2.2 million to $9.9 million (+348%). Infrainguinal endovascular paid claims increased from $8.8 million to $40.2 million, with atherectomy CPT codes consistently comprising 60% to 67% of these charges. No open bypass or groin-level reconstruction appeared in the top 30 paid codes in any study year. Carotid endarterectomy was the highest-cost open procedure (increased from $611,984 to $1,151,122; +88%). Dialysis access costs increased substantially (+252%), led by fistulagram with percutaneous transluminal angioplasty. Vein procedures had the largest percentage increase (+445%).

Conclusions: VA Community Care vascular surgery paid claims increased nearly threefold from FY 2020 to FY2025. Infrainguinal endovascular procedures, particularly atherectomy, represented the largest cost category. All procedural groups demonstrated consistent growth, with vein procedures exhibiting the greatest relative increase. Open bypass procedures were absent from the highest-cost claims throughout the study. These findings characterize the trajectory of VA Community Care vascular surgery expenditures and may inform future resource allocation and policy decisions.