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Thursday, May 24, 2018
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Letter of the Day

The VA’s next predictable dilemma

Now that VA officials have accepted that the agency cannot handle the large numbers of veterans seeking care in VA hospitals, at least in a timely manner, they are frantically trying to pass legislation that will allow veterans to seek care in the community, which will be paid for by the government.

But as has been pointed out, such legislation is not necessary.

It has always been legal to fee-base out medical and dental treatment for eligible veterans. However, as I have noted in the past, the administrators were afraid that would reflect badly on their perceived ability to meet mandated performance standards and interfere with their ability to obtain bonuses.

Now that bonuses are no longer attached to performance standards, that should no longer be a problem.

Now, stand by for the next predictable dilemma:

Veterans organizations are concerned, and rightly so, that it will become quickly obvious that community doctors will have a difficult time handling the large veteran influx into their practices.

The Congressional Budget Office estimates the cost of requiring the Department of Veterans Affairs to provide non-VA medical care to any enrolled veteran who cannot get a VA medical appointment within 30 days, or who lives more than 40 miles from a VA medical facility, at a stunning $54 billion annually.

The number of veterans who fit into those categories is staggering. Consequently, the guarantee that their appointment times will be shortened in the community is questionable at best.

Waiting times in the community, particularly for specialty care, are in many cases as long, if not longer, than VA waiting times.

Although I agree that the veterans should be given a choice, it is a no-brainer that the ability to treat more veterans in the VA system by building more facilities and hiring more health care providers has to be an integral part of the solution.

The obvious concern is that the cost of purchased care will be such that it will inhibit funding for expanding internal capacity for the future through additional hiring of clinicians, purchase of equipment or expansion of infrastructure.

My personal community internist is concerned not only about the numbers but the nature of the acute and chronic conditions that exist in the veteran population.

My personal experience treating veterans in VA hospitals for 15 years leads me to agree with his concerns.

B. Frank Kepley

Sun City Center

The writer is a retired U.S. Navy captain who has worked as an oral and maxillofacial surgeon in two VA hospitals.

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