Healthcare News & Insights

More veterans at private hospitals, may not mean more pay

A new government policy may mean a new influx of veteran patients at private hospitals. Unfortunately, it may also mean a stack of unpaid claims from the VA. 

159291274After about 40 patients passed away and exposed the Phoenix hospital’s secret appointment wait list, the department launched a full investigation into the nation-wide system.

Richard Griffin, the Veteran Affairs (VA) department’s acting inspector general recently released a 35-page report detailing the systemic problems affecting VA hospitals across the U.S. — and the results aren’t heartening.

Internal issues

As Modern Healthcare explains, the 14-day rule at VA hospitals is meant to ensure that veterans are seen in a timely manner. But Griffin’s report showed that the actual average wait time was 115 days for a first-time primary care appointment.

What’s worse is that 1,700 veterans were kept off the Phoenix hospital’s official waiting list, and that bad scheduling practices were found to be systemic throughout the VA’s 150 hospitals and 820 clinics.

Meeting the “14-day” rule often resulted in rewards and bonuses for these facilities, giving them incentive to “cook the books” so it looked like wait times were down. There are now 42 facilities under investigation, with possibly more to come.

On the whole, Griffin’s report highlights the discouraging state of the overall VA health system, not just its poor scheduling practices. In reaction, the Obama administration has issued a new policy to refer veterans to private hospitals to help unburden the VA as it corrects its issues.

An external ‘solution’

The Accelerating Care Initiative was issued this past Memorial Day. According to Modern Healthcare’s report, the Initiative requires VA hospitals to offer referrals to outside providers if veterans have a wait time longer than 30 days for their appointments. In the past, the VA only pays outside providers for emergency care or for veterans who live too far away to access VA healthcare.

The first referrals of the policy began May 30, though it’s expected the policy will take another month and half to fully implement. Although the VA announcement didn’t mention how many patients might be referred, hospitals in states with high veteran populations like Michigan or North Carolina can likely expect a decent chunk of referrals.

Unfortunately, more referrals may just mean more struggles to be reimbursed for serving those veterans for those private hospitals. Before the allegations against the Phoenix VA hospital came to light, the Government Accountability Office released a report discussing claims from non-VA hospitals which were wrongly denied by the department due to administrative issues and poor processes.

“We found that the VA lacks sufficient oversight mechanisms and data to ensure that VA facilities do not inappropriately deny claims,” the report read. And when the VA didn’t pay up, the hospitals had to bill the veterans themselves.

Some professionals for veteran associations are hopeful that the initiative will finally bring some much needed help to veterans in need, assuming the policy is implemented properly by VA facilities and management. Others are less optimistic, since private care facilities have their own waiting list and administrative issues.

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  1. Defting says:

    Apparently the vision of health care in the America’s is even substandard to being held as a prisoner of war under the Geneva Convention, or how each slave in America was treated prior to abolishment, or even how military veterans all inclusive if disabled are treated in comparison to those held within the penal system, or under a system of justice.

    Where do the military veterans have such representation to ensure their rights under the United States Constitution they fought to defend for everyone else, or does it no longer apply in America?