Some private doctors may not accept VA patients

Some private providers might not participate in a program allowing veterans to seek care outside of the Veterans Affairs (VA) health system because of low reimbursement rates, Modern Healthcare reports.

In just two months, 800K vets were referred to private doctors

In January, VA launched its Patient-Centered Community Care (PCCC) program following the receipt of up to $9.4 billion in contracts over five years with managed-care organizations Health Net and TriWest. The contracts allowed VA to develop a network of private providers who offer specialties such as mental health and emergency care for veterans.

Providers have said they are unsure how willing they will be to participate in the expanded program given the low rates. They noted that in some instances, Health Net and TriWest are paying rates below what providers would receive from Medicare.

In addition, hospitals located in states that already receive Medicare reimbursements that are below the national average might not be able to afford to take on cases in which they would receive even lower reimbursements, according to Modern Healthcare.

Meanwhile, a law recently signed by President Obama provides emergency funding to VA to allow more veterans to seek the private care but does not increase these rates, and instead limits them to the maximum paid under Medicare. The bill allows reimbursements above Medicare rates only in highly rural areas, which it defines as having fewer than seven residents per square mile in a county.

An overview of how the new VA law hopes to fix the health system

VA Secretary Robert McDonald says expanding PCCC to included primary care "is another example of how we are working to ensure veterans get the care they need, when they need it and where they want to be seen."

TriWest Vice President of Government Relations and General Counsel Bill Cahill says, "It is true that our providers are accepting a discount of Medicare rates," but adds, "The value we provide is that we pay on time and accurately." Further, Cahill says that paying below Medicare rates allows TriWest to spend fewer taxpayer dollars.

Health Net Communications Director Molly Tuttle adds, "We work with community providers to negotiate acceptable rates within the boundaries of our contract."

Some providers have said their duty to serve veterans outweighs their concerns about reimbursement rates. Tennessee Hospital Association President Craig Becker said, "What's more important is that these folks are getting in front of a doctor. I don't know of any hospital that wouldn't take care of a veteran" (Dickson, Modern Healthcare, 8/14 [subscription required]).

Patient access: More than just getting an appointment


In this video, Southwind's Ayal Bitton shares what his own experiences taught him about the importance of having a robust patient access strategy, and shares three strategies for managing the challenge.


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