A congressional investigative agency is warning that expanding the number of primary-care clinics and physicians treating service-disabled veterans could strain the Department of Veterans Affairs' healthcare budget.
Under its plan to restructure its $16.6 billion, 173-hospital system into 22 integrated healthcare networks that emphasize primary care, the department recently added 12 primary-care access points.
Those access points are defined as VA-operated community-based clinics or private clinics, group practices or practitioners working under department contracts. The VA department operates four of those new access points. The rest are privately owned or operated by county governments. The department plans to open 258 more community-based centers by December.
A General Accounting Office study of the new centers found that about 40% of the 5,000 veterans who have enrolled at them for care are considered to be new patients.
Those new users are likely to be referred to hospitals for further services, which could increase the VA's costs and budgets, David Baine, the GAO's director of healthcare delivery and quality issues, told the House Veterans Affairs healthcare subcommittee.
Kenneth Kizer, M.D., the VA's undersecretary for health, responded that the parent hospitals are required to operate the new centers out of their existing budgets. In addition, Kizer said the department needs to provide more primary-care facilities as it tries to follow the private sector's shift toward less-expensive outpatient care.
The GAO also said the new community-based centers were not adhering to the complicated rules that govern what services disabled and poor veterans can receive. Most veterans receiving care at those centers did not have service-related disabilities and therefore should not have been eligible for all care, the GAO said.
Furthermore, the GAO said the VA does not have legal authority to contract with private-sector primary-care physicians. Under existing law, the department can contract with private-sector providers only for specialized medical resources, and the GAO contended that primary-care physicians do not qualify for specialized medical resources.
Kizer said Congress needs to pass legislation to reform those eligibility and contracting rules. The subcommittee will work on such legislation this week.