Welcome to DU! The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards. Join the community: Create a free account Support DU (and get rid of ads!): Become a Star Member All Forums Issue Forums Culture Forums Alliance Forums Region Forums Support Forums Help & Search

eridani

(51,907 posts)
Wed Jun 11, 2014, 08:09 PM Jun 2014

How VA Outsourcing Hurts Veterans



http://www.pnhp.org/print/news/2014/june/how-va-outsourcing-hurts-veterans

On Thursday, Sen. Bernie Sanders, chairman of the Senate Veterans Affairs Committee, announced that he had reached a compromise with John McCain and other Senate Republicans on how to fix whatever it is that needs fixing at the VA. The legislation contains some good ideas, like providing for the hiring of more doctors and nurses where they are needed. But the bill also contains one provision that is a significant concession to Republican enemies of government. If enacted, it would lower the quality of health care received by veterans while setting back the movement for health care delivery system reform generally.

This is the provision in the draft legislation that would, according to a Senate Veterans Committee press release, “allow veterans living more than 40 miles from a VA hospital or clinic to access more convenient private care.” Given all the headlines about excessive wait times and backlogs at the VA, that might sound smart at first hearing, but in practice it could well lead to a disaster.

To begin with, as most people in this debate don’t seem to know or care to remember, the VA already engages in extensive outsourcing of medical services. For example, under the Bush Administration, the VA began contracting with Humana to provide care to veterans in rural areas, a program that continues under the Access Received Closer to Home project. In 2009, the Senate Veterans Affairs committee determined that the VA was already outsourcing some $3 billion year to private providers.

By 2012, the Obama administration had continued the trend to the point that the public employee unions that represent VA employees were screaming. “Contract physicians and nurses lack the specialized skills and best practices of clinicians who dedicate their lives to serving the veteran population as VA employees,” complained Alma Lee, National VA Council President for the American Federation of Government Employees. “Excessive contracting out has put many medical centers in the red, without benefitting the patient.”

Now to be sure, some of this outsourcing makes sense. It’s not cost-effective to maintain VA hospitals or even clinics in many remote areas. Due to the declining population of veterans, the VA lacks a sufficient volume of patients even in some developed areas to be able to justify using its own specialists.

But even at its current scale, the outsourcing of VA care has already been fraught with problems. One comes from just the generic hazards of government contracting. In 2009, the VA Inspector General (pdf) found that 37 percent of the $3.2 billion the VA had paid out the year before to private health care providers was improperly paid. Not only does outsourcing create new administrative costs and burdens for procuring and managing contracts. It also opens up opportunities for crony deals and all the kinds fraudulent billing by private doctors that bedevils Medicare and Medicaid.

<snip>

CARE COORDINATION IS A VITAL aspect of health and healthcare services. Many patients often see multiple physicians and care providers a year, which can lead to more harm, disease burden, and overuse of services than if care were coordinated. This is particularly evident for people with chronic conditions and those at high risk for co-morbidities, who often are expected to navigate a complex healthcare system. Despite efforts to reduce problems through various initiatives and programs—such as care/case management—poor communication, medication errors, and preventable hospital readmissions are still substantial.

Indeed, they are. And superior coordination of care is one main reason why the VA, despite it flaws, continues to outperform most other health care providers in most measures of health care quality.
2 replies = new reply since forum marked as read
Highlight: NoneDon't highlight anything 5 newestHighlight 5 most recent replies
How VA Outsourcing Hurts Veterans (Original Post) eridani Jun 2014 OP
Having had direct experience with VA outsourcing, I would suggest this is bullshit... TreasonousBastard Jun 2014 #1
And on the other hand... moondust Jun 2014 #2

TreasonousBastard

(43,049 posts)
1. Having had direct experience with VA outsourcing, I would suggest this is bullshit...
Thu Jun 12, 2014, 12:28 AM
Jun 2014

Many VA hospitals are close to major teaching hospitals and use them for advanced testing and treatment where the VA doesn't have the resources. They also hire part-time staff from these hospitals who bring their expertise. Even simple things like colonoscopy is outsourced to centers that do 50 or so a day rather than the 5 or 10 a week the VA hospital might do.

The VA has set up satellite centers for blood collection, some examinations, and televisits with doctors in the main centers. These have worked very well and reduce the transportation problems for many and I find my trips to the main hospital 60 miles away halved by trips to the local center 20 miles away. At the moment, I think some VA hospitals have become so efficient, outsourced so well, and have fewer veterans to serve that some facilities are actually underused. For instance, I have no problem getting an MRI almost on demand and there is no wait at all.

FWIW, I have used the VA since long before Shinseki and I could see improvements when he took over. Railroading him over any problems that still exist is one of the more shameful things I've seen this country do. Shinseki should be admired and honored, not shoulder the entire blame for a mess he did not make but was fixing.

moondust

(19,917 posts)
2. And on the other hand...
Thu Jun 12, 2014, 01:26 AM
Jun 2014

DUer sorefeet says:

The closest VA hospital or close to a hospital is 6 hours to Helena. My friend had to go to Salt Lake for lung cancer chemo. It was miserable for him to hop on a plane and travel that far sick with cancer. Jon Tester has done more for Montana vets than anyone. The clinics are spread out so far because of the size of the state and low population. They have VA vans, that volunteers drive the soldiers for hours to get them to a clinic or the Hospital. Lots of Vets are neglected in Montana just because of location. They are the ones that "fell thru the crack".

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4978151

I'm not sure how big a factor it is but I think the military gets quite a few folks from more remote parts of the country where there aren't many good jobs anymore and where a lot of people grow up learning to be more self-sufficient due to the lack of nearby shopping and services.

Like others, I would be concerned that even though today the perimeter is 40 miles, the privatizers may whittle away at that until there is no perimeter left and any veteran can go anywhere for medical care at taxpayer's expense. Then the gouging of taxpayers begins in earnest.
Latest Discussions»General Discussion»How VA Outsourcing Hurts ...