The Department of Veterans Affairs' proposal to restructure its medical system can succeed only if the VA also changes its healthcare eligibility system, veterans groups and congressional leaders say.
Congressional veterans affairs committees have placed reforming the VA's eligibility criteria-which make it easier for some veterans to receive inpatient care than outpatient care-high on their priority list for the coming session of Congress.
So far, however, only one bill has been introduced. Sponsored by Rep. Chet Edwards (D-Texas), ranking Democrat on the House VA Committee's healthcare subcommittee, the measure calls for the VA to expand its outpatient-care capacity, and to better manage the care of poor veterans and those with service-related disabilities so that they receive the appropriate treatment.
Under current rules, the VA must provide hospital care for those veterans, but its treatment criteria often restrict outpatient services to a much smaller group of the 900,000 patients it treats annually. Because the VA often serves a disproportionate percentage of patients in expensive inpatient beds at its 171 hospitals, the average stay for a VA short-term medical and surgical patient was 9.8 days in fiscal 1993-about one-third longer than the average U.S. short-term patient.
Although late last year, the VA, which has a $16.2 billion medical-care budget, submitted to Congress its plan to reorganize its 721 medical facilities into 22 "veterans' integrated service networks," or VISNs, it is only engaged in "informal discussions" with Congress and interest groups about reforming eligibility criteria, a spokesman said.
But that's not enough to make VA healthcare work, according to veterans groups and congressional leaders.
"It's around eligibility reform that all this should circulate," said David Gorman, deputy national legislative director with Disabled American Veterans. "These VISNs set the stage for this stuff to happen, but it doesn't do it. (With VISNs) you still have to pay a whole lot more to put a guy in a hospital bed."
House VA Committee Chairman Bob Stump (R-Ariz.) plans to introduce an eligibility reform bill in the near future, a committee spokesman said.
The American Legion, meanwhile, is trying to develop its own proposal that not only would expand outpatient care for disabled and poor veterans, but also would allow increased access for veterans outside that group, with the VA to keep reimbursement for those veterans from Medicare and insurance companies.