1996...the reason the VA is in the mess it is in now...

[MORTARDUDE]

entire interview is at :

http://www.legion.org/publications/p...ay03_storm.htm

The American Legion Magazine

May, 2003
Volume 154, Issue 5

A Storm On The Horizon

Interview with National Commander Ronald F. Conley

..........
excerpt
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TALM: What changed?

RFC: VA health care gradually shifted as various legislative changes came into effect. Delivery of care changed from the inpatient model to more outpatient and home-based services. In the 1980s, they started categorizing veterans. You were an A veteran, a B veteran, a C veteran. Means testing was extended to all veterans, and copayments and third-party reimbursements from insurance companies came in. Now it?s priority groups 1, 2, 3, 4, etc., as new and different criteria were established to determine where you fit and how you were categorized.

Some veterans got squeezed out. In Pennsylvania, wives started calling me, wives of veterans who were in VA facilities saying their husbands were being forced out of the system. It used to be VA had some discretion because the system was not nearly so budget-driven as it is now. Families were told to move their husbands and fathers into nursing homes or VA would do it for them. Some VAs would pick up the cost for 30 days, 60 days or 90 days, but from then on, the burden was on the families. We made a push under (former VA Secretary) Jesse Brown and (former VA Undersecretary Kenneth) Kizer to put a moratorium on releasing long-term-care veterans from these hospitals. We were able to get that moratorium passed. Some of those veterans are deceased now, but they ended up staying in their facility, the facility they were used to, and they ended up dying with some dignity.

A veteran is a veteran, no matter what category he or she is put in, no matter what the means tests conclude. In the late 1990s, VA expanded enrollment, and care was made available to all who served. It was a good deal in many ways, and VA actively reached out to veterans who did not know they now were eligible for health-care benefits. VA aggressively marketed to get them to enroll. And they did.


TALM: What was the problem with that?

RFC: They expanded the system and took in more veterans, but they didn?t substantially change the budget. The philosophy of a VA for all veterans was great, but paying for it was a different story. That?s how we got into the rationing of health care. That?s what you do when you don?t have enough to go around. You ration.


TALM: Didn?t VA?s ability to collect third-party payments offset the cost of handling the greater patient load?

RFC: The Veterans Health Care Eligibility Reform Act of 1996 told veterans they could all come. ?Come on, enroll in the system,? we were told. And yes, VA was able to start collecting and retaining first- and third-party reimbursements. But you have to understand that they cannot collect Medicare. That?s a big difference between VA and other hospitals. And even though VA could bill third parties, they had to jump through several hoops. They had to learn how to bill insurance companies. A lot of health-insurance policies back then said if you received care through a federal institution, you were exempt from coverage. That meant they had to change the law. Even then, some companies still did not pay dollar for dollar. It took education, and it took time.

Once VA learned the billing process, they got pretty darned good at collecting first and third-party reimbursements. But now, every time a VA hospital director beats his target for those collections, the target is raised. That director does not benefit from having beaten the target. The reward for a surplus at the end of the year is a higher collection target the next time around. We have found this everywhere we have gone this year. In one state, the target was $10 million; they collected $13 million in third-party reimbursements, and so the target was raised to $15 million. And if the directors don?t collect that money, they have to find it somewhere else, or they have to cut, if they want to meet their budget.


TALM: When targets cannot be hit, what are the options?

RFC: Medicine, by its very nature, is labor-intensive ? doctors, pharmacists, nurses, medical staff, administrators. There are several things you do if you need to cut costs in a medical facility. You put off purchases, facility maintenance and minor construction. You cut back on employees. That?s the quickest way. In places where the budget isn?t sufficient to meet demand, cutting costs means cutting people. VA has empty beds and empty wards because they have been systematically downsizing VA ? both the people and facilities ? because of a lack of dollars.

Facilities inside VA compete to see who can cut costs more. One VISN director had a million-dollar slush fund he was paying to employees who came up with ideas about how to cut costs. It became very aggressive among employees trying to access that money. You can?t do that. You cannot push people out of the system to save money ? just get rid of them to get rid of the cost. I told them that.

[BLUEHAWK]

It costs us, plus or minus, $4,000,000,000 monthly to operate the war in Iraq.

A single Patriot missile battery cost $200,000,000 in 1994.

A single Abrams tank used to cost $2,600,000, we have roughly 8000 of them.

[SuperScout]

And your point is......???
Comparing the cost of an Abrams to the inefficiencies, fraud, waste and abuse prevalent in the VA health system is similarly idiotic as trying to find philosophy on a bumper sticker. I would advise not playing the "look at all the bullets you're buying" argument in trying to generate criticism for the war in Iraq, the cost of an Abrams, or other expenditures that many feel are relevant to our national defense.

[BLUEHAWK]

Hi Scout -

Well, it would not hurt the defense budget all that much then to make sure the VA and our vets got exactly what was promised to them, right?

8,000 x $2,600,000 is a helluva lot of money, and some from that project or another one or ones could surely be spared to care for vets without taking the view that the weapons are irrelevant, no?

I'm not playing look at all the bullets Scout, I never would. America has gotta be forthcoming with what our sick vets need... so I'm trolling among friendly fishes (the rest of 'em ain't on Patriot Files).