Posted on Feb 1, 2019
“Doubling Down”: With Private Care Push, Trump’s VA Bucks Lawmakers and Some Veterans Groups —...
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"What is clear about the new rules is that they are dramatically more permissive. The new drive-time standard alone will make 20 percent of veterans eligible for private primary care and 31 percent eligible for private specialty care, up from 8 percent for both kinds of care under the old program, according to a briefing document circulated on Capitol Hill."
“Doubling Down”: With Private Care Push, Trump’s VA Bucks Lawmakers and Some Veterans Groups —...
Posted from propublica.org
VHA
Health
Veterans of Foreign Wars (VFW)
Mission Act
Posted >1 y ago
Responses: 3
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Michael Compeau
The 'funding', per se, is not an issue. As I understand it, once a veteran's need is diagnosed, there is no further 'approval' required, there is never a budgetary limit imposed; 'Required care' is performed, per the provider's judgement. There is no 'rationing' of care in the VHA.
This is to distinguish between actual 'health care' at the VHA and the determination of disability rating (a VBA function), appeals to those findings, etc.-- Those are Veterans Benefits Administration determinations, which VHA has no involvement with, in most cases.
So, the real question related to 'paying for' the Community Care appointments relates to the Veterans' Choices made: how many, among those who will become eligible under the new access standards, will CHOOSE to use a non-VHA provider, due to either the drive time standard or the wait time standard.
Keep in mind that under the Mission Act, if the wait time for the non-VHA provider actually IS LONGER than the VHA provider wait time, (which research released only months ago has shown to frequently be true) the Community Care may be excluded; The goal is TIMELY care, not just 'local care'.
This is to distinguish between actual 'health care' at the VHA and the determination of disability rating (a VBA function), appeals to those findings, etc.-- Those are Veterans Benefits Administration determinations, which VHA has no involvement with, in most cases.
So, the real question related to 'paying for' the Community Care appointments relates to the Veterans' Choices made: how many, among those who will become eligible under the new access standards, will CHOOSE to use a non-VHA provider, due to either the drive time standard or the wait time standard.
Keep in mind that under the Mission Act, if the wait time for the non-VHA provider actually IS LONGER than the VHA provider wait time, (which research released only months ago has shown to frequently be true) the Community Care may be excluded; The goal is TIMELY care, not just 'local care'.
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I'm on the fence on this one, mainly because of the cost. The VA is able to save on cost because they negotiate prices for things like medical equipment and prescriptions for the entire VA and not just a geographical area like private hospitals do. They also save money by having workers on the government pay scale. The idea I think may work for those that are far away from a VA facility. For primary care, the VA already has clinics that lower the number of people that live outside of the range for primary care. For specialty care, it will work better because the VA Hospital is limited in the number of people it can see in each specialty clinic. The one thing that will upset this apple cart is communicating medical records and prescriptions between the VA and private providers. The VA will need to have a system that can interface with thousands of systems already in use by private providers. Private providers will not invest that type of money to make their systems compatible so it will be on the VA to make that happen. That is going to cost money and take a long time.
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MAJ Ken Landgren
I heard the administrative costs will be around 3 billion to coordinate private clinics with the VA. I am concerned with the coordination, but I do hope for the best. What concerns me is will medical and good business guidelines be used?
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Talking about me. I'm 38.5 miles from the VAMC. One and a half miles under the previous rules. But I'm also 50 minutes away driving time.
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