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Local group sees issue as symptom of larger veterans’ healthcare problem

Editor’s note: This story uses information from a USA Today story as well as information from the Federal Daily.

HOT SPRINGS – A Government Accountability Office report, cited in USA Today and in the Federal Daily, refers to a study that shows Department of Veterans Affairs has wrongfully denied claims for emergency care for its veterans.

According to the report, VA staffs at four facilities – including the VA Black Hills Healthcare Systems – denial of claims did not comply with the requirements of the Millennium Act, which authorizes the VA to cover veteran’s emergency care for conditions not related to service-connected disabilities, when no VA healthcare is available.

Members of the Hot Springs Save the VA Committee see the denials as one of the symptoms of problems that arise when veteran’s healthcare is provided by local entities. The local group responded to specific questions from the Hot Springs Star regarding the report and veterans healthcare.

“The report says the General Accounting Office reviewed four facilities of 142, based on spending levels and geographic locations,” said the Committee. “Black Hills Health Care System was chosen ‘because they serve veterans who live in rural or highly rural areas, according to VA’s Office of Rural Health.’ The Hot Springs VA Medical Center has traditionally provided care for these veterans. The report doesn’t indicate what the potential total is, but our feeling is that with the review looking at only two percent - 4 of 142 facilities - there are likely many more cases. The Black Hills Health Care System is one of the smaller VA medical systems within the Veterans Administration. It would lead one to believe that larger medical centers would have more claims for the millennium bill.”

At the four VA facilities examined in the GAO report – others were in Washington, D.C., Vermont and Texas – 66 instances of non-compliance were found among the 128 denied claims that the report reviewed. The GAO also found that VA facilities may not be notifying veterans that their Millennium Act claims have been denied – in fact 83 of the 128 denied claims showed no documentation that veterans were notified either of their denial or their right of appeal.

Following are additional responses from Save the VA.

Hot Springs Star - Why should the report that Millennium Claims are not being paid by the VA be a concern?

Save the VA - The report is concerning because this is not just something that’s happening nationwide, the report specifically identifies VA Black Hills in fiscal year 2012. This is happening here and now and while it’s only one type of claim, it’s not a far stretch to think about the sort of difficulties non-VA providers would have in dealing with fee-basis care if the proposed closure of the Hot Springs VA happens. We think the following from the GAO report, “veterans whose claims have been inappropriately denied may have been held financially liable for emergency care that VA should have covered” should concern every veteran who receives emergency care outside a VA facility.

HSS - Does Save the VA see this as a problem that the VA has paying other medical claims with private healthcare facilities?

STVA - Yes, some of the many factors that need to be considered to determine who is responsible for the medical costs of veterans care are the Millennium Act and whether the veteran has a service connected disability. This determination is more difficult and prone to error when the veteran receives care outside a VA facility.

 Also, the Veterans Administration is currently rolling out a program known as Patient Centered Community Care (PC3). This program allows veterans to see providers in the private sector and the VA claims that they will pay these bills. If we are seeing problems with the payment of millennium bill claims, we believe that there will also be issues with the Veterans Administration paying the claims under Patient Centered Community Care.

HSS - Could this small sample of a specific set of claims be a symptom of a larger issue?

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STVA - Certainly, but without investigating all 142 VAs, it’s difficult to say. From the report, it seems there are national guidelines in place for parts of the process and other parts of the process are left to the local level.

The larger issue appears to be that the Veterans Administration wants to move away from providing health care in-house. What we have seen over the last 10 years indicates a movement to moving medical care to the private sector and the Veterans Administration claims they will pay the bills. Outsourcing medical care is more expensive for the taxpayers and we believe that the veterans will not receive the comprehensive care they currently get in the VA.

HSS - The Millennium Claims are designed so veterans can get emergency care from a private facility if needed. Could the need for private healthcare be lessened if more VA facilities were operational to handle emergency situations?

STVA - Yes, that’s what the Save the VA effort is all about. The millennium bill is necessary so that rural veterans will have timely access to emergency room care. That’s a good thing for veterans. However, veterans who will need longer stays in the hospital will be better served by having the VA hospitals provide their care. The cost to the taxpayer would be approximately half the cost of placing these veterans and private sector hospitals.

HSS - In Hot Springs’ case, if a veteran was injured in an accident, his or her first option would be Rapid City – an hour-and-a-half away after an ambulance responded. Wouldn’t having a fully-functional ER at the Hot Springs ER alleviate that trip?

STVA - Yes, but the situation described is specific to Hot Springs. If a Hot Springs veteran is traveling outside of Hot Springs to visit family or friends and has an accident that requires emergency treatment the veteran should go to nearest emergency room first. As stated previously, the Millennium Act is a necessity for all veterans; whether they are rural veterans or urban veterans. If an emergency arises and they are not close to a VA medical Center the veteran should have an option to receive care at the nearest medical facility.

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