This is a step in the right direction if they can get it passed.


WASHINGTON – Nearly four times as many veterans could be eligible for private health care paid for by the Department of Veterans Affairs under sweeping rules the agency proposed Wednesday.

The rules, which will be open to public comment, would permit veterans to get private care if they had to wait more than 20 days or drive more than 30 minutes for a VA appointment.

That would be a considerable expansion of eligibility standards, in which private options kick in for vets who have to wait 30 days or live 40 miles from a VA facility. The new rules would allow veterans who need urgent care to go to a private doctor without pre-authorization.

If they go into effect, the rules would deliver on a presidential campaign promise made by Donald Trump to expand choices for veterans seeking health care outside the VA.

VA officials estimated the plan could increase the number of veterans eligible for private care to as many as 2.1 million – up from roughly 560,000.


The proposal has already drawn sharp rebukes from critics who say the changes go too far and would drain money from the VA and lead to its privatization.

“This will significantly increase the overall cost and amount of care VA will send to the community,” a group of more than two dozen Democratic senators wrote in a letter this week to VA Secretary Robert Wilkie. “Given that the administration opposes increasing overall federal spending, these increased costs for community care will likely come at the expense of VA’s direct system of care. And that is something we cannot support.”

In a statement, Wilkie said claims the rules would lead to privatization are unfounded.

“Here are the facts: under President Trump, VA is giving Veterans the power to choose the care they trust, and more Veterans are choosing VA for their health care than ever before,” he said.

VA officials said that even though more veterans would be eligible, the agency doesn't expect a significant number would choose private care.

“Most Americans can already choose the health care providers that they trust, and President Trump promised that Veterans would be able to do the same," Wilkie's statement said. "With VA’s new access (rules), the future of the VA health care system will lie in the hands of Veterans – exactly where it should be.”

Under legislation passed by Congress and signed into law by Trump last year, the VA was tasked with combining a half-dozen different programs that allowed veterans to get VA-funded private sector care and coming up with rules governing when veterans could opt to go private.

Under the proposed regulations, according to the VA announcement Wednesday:

• For primary and mental health care, veterans who had to wait more than 20 days or drive more than 30 minutes for a VA appointment could choose to go to private doctors instead.

• For specialty care, veterans who had to wait longer than 28 days or drive more than 60 minutes to be seen at VA could go private "with certain exceptions."

• For urgent needs, veterans could select a private clinic approved by VA and walk in when they needed to, but they might be responsible for a co-payment.

VA said it encourages public comments on the proposed regulations. "We look forward to receiving this feedback," the agency said.



https://www.usatoday.com/story...va-rules/2720456002/

I hope it passes

whatever the outcome post-legislation, it cannot be any worse than the abysmal treatment the VA gives veterans today

The VA Healthcare System should have been shut down years ago. It is a colossal waste of money and resources (even worse than IHS) in an age when it is completely unnecessary.

Shut it down.

Allow retirees and those with service connected disabilities to seek care privately, and turn every existing VA hospital into inpatient mental health facilities.

We save billions, eligible vets get better care, and we help solve the mental health crisis.

Win win, and win.

The current VA Choice program has some serious issues. The payments to the doctors are set at very low rates, records are required to be sent, and the company administering the contract simply has a poor track record in terms of paying doctors. As a result most local doctors are not interested in the business.

{The Choice program supposedly allows vets to see private doctors if they meet distance criteria or have to wait for a long time for an appointment}.

quote:

Originally posted by Gustofer:
The VA Healthcare System should have been shut down years ago. It is a colossal waste of money and resources (even worse than IHS) in an age when it is completely unnecessary.

Shut it down.

Allow retirees and those with service connected disabilities to seek care privately, and turn every existing VA hospital into inpatient mental health facilities.

We save billions, eligible vets get better care, and we help solve the mental health crisis.

Win win, and win.

totally agree


---------------------------------------------

I was dropped last month from my physical therapist because they VA hadn't paid bills since September. So on top of demanding lower rates, they then take forever to pay their bills.

My surgeon was quite upset, but in the end we both have the same healthcare and even he is reliant on the nurse practitioner to do her job...being as she is the primary care doctor for all of us veterans on the entire Kenai peninsula.

Nurses hired to do doctors jobs. She's nearly killed me twice in drug interactions. I run everything by my father prior to taking it (he's a GP Doc, and prior USAF Flight Doc).

It takes months to get appointments. Going downtown is a joke because no one here will accept the VA coverage.

quote:

Originally posted by ZSMICHAEL:
The current VA Choice program has some serious issues. The payments to the doctors are set at very low rates, records are required to be sent, and the company administering the contract simply has a poor track record in terms of paying doctors. As a result most local doctors are not interested in the business.

{The Choice program supposedly allows vets to see private doctors if they meet distance criteria or have to wait for a long time for an appointment}.

This. Someone said it couldn't get worse, well worse would be no care, and nowhere else to go. Unless the reimbursement rates and government red tape are fixed concurrently, dumping every Veteran into the private sector could be an unrelenting disaster. Yes, VA care is awful in some regions, mediocre in others, and pretty good in others, you may have even had a personal bad experience in the VA, or knew someone's brother's aunt's cousin who did - over 7 million patients received care last year in the VA system, not counting nursing homes and long term care. Unbelievably, all of them weren't unhappy or had bad outcomes. The VA employs more people than are in the active duty Air Force, across every state and 1,243 health care facilities, including 170 VA Medical Centers and 1,063 outpatient care sites. It has a budget of almost $200B. If it were in the Fortune 500, it would rank number six. That's a lot of healthcare to realign with the stroke of a pen, by this afternoon. And just dumping the money onto the private sector doesn't get you health care - you can't just buy a commodity there isn't enough of to begin with. And it's going to get worse.

If you like your doctor you can keep your doctor - dismantling the VA means you can't keep your doctor if you'd rather be a VA patient, and hopefully there are some on this forum who would have a problem with that. I'm not an apologist for the VA, but the private sector is frankly overloaded right now, and not standing on the street corner for a few million additional (about 9.3 million to be exact), multiple co-morbidity, extremely medically complex patients to be seen immediately at cut rates. Many can't keep up with their current caseload. Quite a few of our local groups and institutions refused to see Veterans after participating in the ever downwardly spiraling "no choice" program. Important services, like Orthopedics and ENT. CEOs of large medical corporations are very interested in acquiring the VA's patient base (and they assume Federal dollars), so they foursquare support privatization. Their network providers and hospitals, not so much.

So unless several things are fixed simultaneously - reasonable reimbursement rates and timely payment, boost and reward those VAs actually outperforming civilian peers - yes, there are some, by every measure, fix our medical schools (perhaps many of you don't realize the VA trains 60% of the physicians in the US, so closing the VA you just closed 60% of your medical schools' graduate training programs, along with some of the most important research facilities, specifically geared, by the way to Veteran illnesses - think first liver transplant in the US), keep politicians and politics out of the healthcare business to the extent possible - the cure will be far worse than the disease. For those of you really interested in understanding the problem: The Battle for Veterans' Healthcare. I certainly don't agree with everything she says, but the future and ongoing conversation should be based at least partially on empirical facts, which many groups either don't have or ignore for their own agenda.

This message has been edited. Last edited by: Doc H.,

quote:

Originally posted by AKSuperDually:
I was dropped last month from my physical therapist because they VA hadn't paid bills since September. So on top of demanding lower rates, they then take forever to pay their bills.

I finished all 12 of my PT visits in 2017 when my provider finally told me they hadn't been paid for any visits. So not wanting to burn bridges I did what I could from my end to help get them paid. TEN MONTHS LATER they finally got paid, and only after the provider sent the requested PAPER COPIES of the bills to some VA Choice billing center in Wisconsin. Getting them paid was a complete goat rope.

When my VA doc offered more PT this year I refused, explaining how I wasn't going to embarrass the VA by having another physical therapist go through the same non-payment bullshit. She was shocked at my experience and didn't have a clue how badly the program is being run.

Edited to add: Yes, Doc H. I'm one of the forum members very happy with the care I receive at my VA. But I go to the Fort Worth facility and stay away from the Dallas VA Center as much as possible.

quote:

Originally posted by Tailhook 84:

quote:

Originally posted by AKSuperDually:
I was dropped last month from my physical therapist because they VA hadn't paid bills since September. So on top of demanding lower rates, they then take forever to pay their bills.

I finished all 12 of my PT visits in 2017 when my provider finally told me they hadn't been paid for any visits. So not wanting to burn bridges I did what I could from my end to help get them paid. TEN MONTHS LATER they finally got paid, and only after the provider sent the requested PAPER COPIES of the bills to some VA Choice billing center in Wisconsin. Getting them paid was a complete goat rope.

When my VA doc offered more PT this year I refused, explaining how I wasn't going to embarrass the VA by having another physical therapist go through the same non-payment bullshit. She was shocked at my experience and didn't have a clue how badly the program is being run.

Edited to add: Yes, Doc H. I'm one of the forum members very happy with the care I receive at my VA. But I go to the Fort Worth facility and stay away from the Dallas VA Center as much as possible.

Yeah, they told me after they had been seeing me for numerous times...for free. I'm one who gets to pay co-pays for my VA healthcare, and I paid them all of my co-pays as they were billed. The named PT business partner offered to meet with me and work something out to keep getting care, but I declined. I don't need to be on the hook for those $300 visits. My copay was enough.

I may have mentioned this before, the true cost of the VA includes a lot more waste and pissing money away than they let us know. All these VA facilities need medical staff; then there are a multitude of medical assistants that must be paid. The administrative astaff which does the book work needs $$. Then you have the staff which keeps the buildings clean (sort of), the cooks (don’t forget the cost of food/drinks) and laundry people, as well as the grounds keeping staff and related mowing and snow removal equipment and their maintenance. We won’t even mention the counselors and so-called psychiatrists. The saving by doing away with this wasteful appendage of gov’t would easily be an improve to veteran health care. And probably build a wall too.

quote:

Originally posted by greco:
I may have mentioned this before, the true cost of the VA includes a lot more waste and pissing money away than they let us know. All these VA facilities need medical staff; then there are a multitude of medical assistants that must be paid. The administrative astaff which does the book work needs $$. Then you have the staff which keeps the buildings clean (sort of), the cooks (don’t forget the cost of food/drinks) and laundry people, as well as the grounds keeping staff and related mowing and snow removal equipment and their maintenance. We won’t even mention the counselors and so-called psychiatrists. The saving by doing away with this wasteful appendage of gov’t would easily be an improve to veteran health care. And probably build a wall too.

Most here will understand that the above is the "true cost" for any healthcare organization - you don't just pay for a so-called doctor and his/her black bag - passed on to you, the consumer, either directly, or indirectly through insurance or again, the Feds. Not even considering rent and construction, supplies, pharmaceuticals (usually about 20% of budget), etc. You, the patient, pay for the pretty pictures, shiny floors, and clean elevators at Mass. General. A lot.

So let's use Scenario 1: scrap the VA, return the budget. It goes, of course, back to the Treasury, for the respective Appropriations Committees to allocate with a new budget. The efficient Federal Treasury. All $200 billion. That's a lot of cash on the table for the likes of Pelosi and AOC. Now no longer protected and earmarked specifically for your Veteran healthcare. Oh, you could try to get that, but now you're working with a Democrat House, and believe it or not, not every Republican has your, the Veteran's, best interests at heart. Fewer of them in fact have ever seen military service. And 2020 is very much unknown.

So back to the $200 billion. That was for the old, inefficient VA. Probably $100 billion will do, at least for the first year. Or maybe $50 billion. Then we'll see. We'll add more if we need to. Later. But we do need a Wall. And healthcare for all, particularly our new Dreamers, not just Vets. And we'll need a third party contractor to administer the program - my brother-in-law has just the company. And we'll need to, you know, set some rules for eligibility. And benefits. To stay within budget and all. And pay for the contractor.

Jests aside, if any of you have actually worked on the Beltway, this is a chillingly real vision. I can tell you it haunts the dreams of Veterans' organizations that do work there. So, as they say, it's complicated.

"There are two great disapointments in life. Not getting what you want, and getting it." GBS

I have about 15 veterans I drive to the VA in Ann Arbor, MI. They are all happy with the care they receive. They don't even complain about the hour and half travel time. Great bunch of guys.

quote:

Originally posted by 9mmnut:
I have about 15 veterans I drive to the VA in Ann Arbor, MI. They are all happy with the care they receive. They don't even complain about the hour and half travel time. Great bunch of guys.

An excellent point, and I neglected to outline Scenario 2 - your personal healthcare experience, following 1. You no longer get your care with other Veterans. You get it alone, an insurance beneficiary on the Federal dole, along with patients from another hundred or so other insurance carriers, who probably pay better and faster. You are "Smith," patient ID# 165478965428. No one gives a damn about your service, or where you served, or who you were. We care about your insurance card, which, by the way, we need to copy, and here are our payment rules. You understand you will be responsible for any unpaid balances by your insurance company. The first 'F bomb" we hear, or pounding on the counter, or dirty looks, you are banned from this facility. Have a seat.

No external agency will be monitoring our wait times, or quality of care, or surgical outcomes. Our physicians and support staff are licensed and properly credentialed, we hope. Oh, the Joint Commission may peek in every three years or so, because we get Federal dollars, but our performance is monitored by our own Executive Committee of the Medical Staff. And our CEO. We are for profit, after all. No Congressional Committees, no Whistle Blower Protection, no IG. If we screw up, you can complain to our Chief of Staff, he'll really be interested in what you have to say. Or sue. If you can afford it. We'll gladly pay you. If you win. If you die, your family has the same options - did you know that medical errors are the third leading cause of death in the US? Good luck, and enjoy your stay.

quote:

Originally posted by AKSuperDually:
I was dropped last month from my physical therapist because they VA hadn't paid bills since September. So on top of demanding lower rates, they then take forever to pay their bills.

My surgeon was quite upset, but in the end we both have the same healthcare and even he is reliant on the nurse practitioner to do her job...being as she is the primary care doctor for all of us veterans on the entire Kenai peninsula.

Nurses hired to do doctors jobs. She's nearly killed me twice in drug interactions. I run everything by my father prior to taking it (he's a GP Doc, and prior USAF Flight Doc).

It takes months to get appointments. Going downtown is a joke because no one here will accept the VA coverage.

So...lets do it for everyone! Do these Democrats calling for this not understand that their plan would be a disaster?

Certainly the system is broke as is. Bottom line is fix it, both the medical and the administration/ billing end of things.
Get heads rolling at every level- right now many of the .gov workers in the system are close to immune from disciplinary actio. If they are weak or incompetent.
I personally think some privatization is a good thing. But get the hard working providers paid promptly!
Don’t beat up nurse practitioners. Overall they do a great job, most people will tell me they would prefer one to an MD. NP’s and PA’s are the wave of the future in all aspects of medicine. why? Because with all the layers of bs and administrative burden that have developed in medicine in the last 30 years, fewer people have an interest in devoting over a decade of time and great expense in education to have a system ( bad term as there is little systematic about it) that is so frustrating to work with

The only thing I've done at the VA is my Tinnitus and Hearing Loss. I've been to the Audiologist a few times to get my hearing aids adjusted and she's really nice.
I need glasses but I've never been to a PC at the VA and they tell me I need a referral to go get my eyes checked.
So by the time I do all the stuff to make trips to get set up with a PC just to get them to say I can go get glasses I could go spend a hundred bucks at America's Best