The Department of Veterans Affairs and a congressional committee are drafting bills that aim to increase reliance on outpatient care at veterans hospitals.
The VA's bill would permit physicians to determine the most appropriate and cost-effective treatment for veterans seeking care at the nation's largest healthcare system, which has a $16.2 billion budget in the current fiscal year.
The House Veterans Affairs Committee also is preparing a bill, although the committee did not make a copy of its legislation publicly available last week.
Today, rigid eligibility rules restrict outpatient care to a smaller group of veterans than those entitled to hospital care. That means the VA relies on costly inpatient beds in cases that in the private sector would normally require only outpatient care.
Eligibility is based on disabilities, income and other factors.
The VA's legislation would eliminate separate eligibility criteria for inpatient, outpatient, nursing-home and other types of care. Kenneth Kizer, M.D., the VA's undersecretary for health, said that change would allow the VA "to provide the right care at the right place and the right time for the right price."
When proposing such reforms in May, the VA estimated net savings of about $268 million over two years (May 29, p. 8).
The VA's bill also would allow the VA to retain part of the third-party insurance payments that now go to the Treasury Department, which it said in May would bring in an additional $81.3 million for VA and $244.1 million for the Treasury over five years.
But the General Accounting Office, Congress' investigative arm, warned that the VA's bill could cost the government money or lead to greater rationing of care. That's because by easing the eligibility rules, the VA could cause increased demand for healthcare services.
The VA legislation is still in draft form but is expected to be introduced soon. Kizer touted the bill last week in a hearing before the House Veterans Affairs Committee.
The committee's eligibility reform draft, Kizer said, doesn't eliminate many of the complex rules that keep veterans from receiving outpatient care. Other critics contended that it would improve services to some qualified veterans by cutting off healthcare for others with minor service-related disabilities.