OPINION AND ANALYSIS
I am very troubled by several things related to health care for our Veterans. I must disclose off the top that I am a Veteran who has received good care at times and questionable care at times. My concerns are: quality of care, wait times, media coverage of those issues, Congress’ reaction, and the American Legion’s response to recent issues.
This month, Congress passed a bill that supposedly “makes it easier for veterans who have encountered delays getting initial visits to receive VA-paid treatment from local doctors instead.” Pundits and elected officials, including the President, are acting as if this is a “brand new procedure” and they are “pioneering new care.”
But this is nothing new… I have received care by doctors, outside of the V.A. Medical Centers, and paid by the VA, for five years. In the last four years, non-VA purchased care has doubled from $2.2 billion in FY 2007 to $4.5 billion in FY 2011 according to figures provided by the American Legion.
Title 38, of the United States Code which was written in 1958, and substantially revised in the 1990s and this decade, states when VA facilities are not “capable of furnishing economical hospital care or medical services because of geographical inaccessibility or are not capable of furnishing the care or services required, the Secretary may contract with non-Department facilities in order to furnish medical care. If a medical service or procedure cannot be provided in a timely manner by VHA due to capability, capacity or accessibility, the service may, with approval, be “fee-based” or contracted outside of the VA.
I have utilized this process for minor surgery over the past five years, so it is not new and Congress should stop puffing its collective chests and patting themselves on the back. The Fee Basis Unit processes payment to non-VA providers who have been issued formal authorizations by the medical centers to deliver care. For example, the Washington D.C. VA Medical Center does not provide certain women’s health services. When such services are determined necessary, a VA provider will initiate a consult, requesting approval to send the patient to a non-VA provider. If that request for a non-VA authorization is approved, the Fee Basis office will process payment to the provider after the services are provided.
The White House said last week that President Obama supports the bill. That’s nice but it has been in place for decades, and no one is talking about this…. Until now.
The Senate bill would authorize about $35 billion over three years to pay for outside care for veterans, as well as hire hundreds of doctors and nurses and lease 26 new health facilities in 17 states and Puerto Rico. The Veterans Affairs Department released an audit showing that more than 57,000 veterans have had to wait at least three months for initial appointments. Another 64,000 veterans who asked for appointments over the past decade never got them.
That is a tragic situation, and I too have encountered it. I wrote some in-depth, investigative reports on problems within the V.A. healthcare system, one of which can take you to links to the others http://www.examiner.com/article/vfw-not-concerned-with-large-staff-bonus....
I was appalled at the milk toast reaction by the Veterans of Foreign Wars in that article, and I am currently troubled by how the American Legion does not work with news media or writers like me. I had been asking the American Legion for a reaction to my articles for several months, often calling their public relations department and leaving email messages and requests. Finally, a John Raughter from the American Legion responded with an email to me saying, essentially, “read our news release.” This is not a professional response from a public relations division but here are some of the “news release comments….”
“The VA should be commended for conducting this audit and for additional action announced by Acting Secretary Sloan Gibson,” American Legion National Commander Daniel M. Dellinger said. “The fact that more than 57,000 patients – a population equal to that of Ocala, Florida – have waited more than 90 days for initial appointments is disgraceful. Even worse, is that an additional 64,000 enrolled over the past 10 years have been unable to get appointments. This is not just ‘gaming the system.’ It’s Russian roulette and veterans are dying because of the bureaucracy.” Dellinger said that Gibson’s order to establish a new patient satisfaction measurement program, hold senior leaders accountable, increase transparency and remove 14-day scheduling goals from employee performance contracts are positive steps. Dellinger has called for criminal investigations of all Department of Veterans Affairs (VA) employees responsible for "secret" waiting lists at VA hospitals linked to the preventable patient deaths, after a May 28 interim report by VA's Office of Inspector General found the practice to be "systemic."
Dellinger called for the resignations of VA Secretary Shinseki and Under Secretary Hickey, but also the chief administrators of every hospital found guilty of falsifying their waiting lists for patients. Shinseki fell on the sword for Obama.
Unfortunately, the American Legion has yet to respond to my specific questions posed about exorbitant bonuses paid to VA medical center staff. I’m a patient writer; I’ll give them more time and then update the story.