New policy will refer some veterans to non-VA hospitals

Private hospitals may have to shoulder the burden, groups say

A new federal policy could relieve the overwhelmed Veterans Affairs (VA) health system by referring more patients outside the VA, but some worry it will strain civilian hospitals that must deal with the VA's delayed reimbursements process, Virgil Dickson writes in Modern Healthcare.

The proposal comes as federal investigators investigate a Phoenix VA facility facing allegations that it put patients on "secret waiting lists" that may have resulted in patient deaths because of delayed care. On Wednesday, the VA inspector general revealed findings of his initial investigation, which found that the average wait time for an initial appointment at the facility was 115 days—far longer than the 26 days the hospital claimed and well beyond the agency's goal of a maximum 14-day wait.

Inspector: Wait time at Phoenix VA hospital averages 115 days

The inspector general also said that the tactics used at the Phoenix hospital were "systematic throughout" the VA health system. He is now investigating 42 VA health centers.

Details of the new policy

Under the new Accelerating Care Initiative, which the White House and the VA announced over Memorial Day weekend, VA facilities will offer patients on their wait lists referrals to other providers if the VA facility cannot treat the patient within 30 days. Veterans will only be able to seek care at private clinics and hospitals in areas of care where the VA's capacity is limited.

VA facilities will begin making referrals on Friday, but it may take up to 90 days to fully implement the policy, Dickson writes.

The VA has in the past reimbursed facilities that provided ED care to veterans and care to veterans residing in rural areas without access to a VA hospital. In fiscal year 2013, the VA paid such facilities $4.8 billion (about 10% of the system's budget) for providing care to one million veterans.

Obama says he 'will not tolerate' issues at the VA. Here's his plan.

Hospitals worry about slow reimbursement process

In response to the new policy, associations representing hospitals in areas with large veteran populations expressed concern about their facilities getting reimbursed for treating veteran patients.

"Because our hospitals have historically experienced challenges with timely reimbursement for VA patients, we are awaiting further information from our federal partners as to any modifications to payment policies," says Julie Henry, a spokesperson for the North Carolina Hospital Association. The state is home to as many as 950,000 veterans, according to VA data.

Moreover, a recent Government Accountability Office (GAO) report found that the VA has been wrongly denying claims from non-VA hospitals because it "lacks sufficient oversight mechanisms and data to ensure that VA facilities do not inappropriately deny claims." When the hospitals did not receive reimbursements from the VA, they often billed veterans directly, according to the GAO report.

For veterans in these nine cities, claims take more than a year

Can non-VA facilities provide veterans with appropriate care?

Meanwhile, Craig Bryan, director of the University of Utah's National Center for Veterans Studies, says non-VA facilities may lack an understanding of "veteran culture and how they can experience something like [post-traumatic stress disorder] differently from other patients… [which] could lead to many servicemen who seek out care to drop out of treatment prematurely."

However, Terri Tanielian, a military and veterans health policy expert at the RAND Corporation, says that treating service-related health issues should be no different than when facilities treat other rare conditions (Dickson, Modern Healthcare, 5/28 [subscription required]).

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