This study quantifies a major shift in locus of VA critical care, a likely outcome of expanded non-VA health insurance coverage that was previously called out, but the study was not designed to address the many issues raised by outsourcing so much ICU care, including questions about the coordination and continuity of post-ICU care for these patients with high-acuity conditions. The study adds to concerns about VA’s ability to oversee the quality of community care and gaps in the integration of VA-delivered and VA-purchased care.