“Because our hospitals have historically experienced challenges with timely reimbursement for VA patients, we are awaiting further information from our federal partners as to any modifications to payment policies associated with (the) announcement,” said Julie Henry, a spokeswoman for the North Carolina Hospital Association. That state is home to about 950,000 veterans.
Similar concerns were raised in Michigan, with an estimated 1 million veterans. “Michigan hospitals operate on tight operating margins … so slow reimbursement can add to the financial burdens hospitals endure,” said Laura Appel, vice president for federal policy and advocacy for the Michigan Health & Hospital Association.
Still, the North Carolina and Michigan associations stressed that their member hospitals will treat any veterans who come through their doors, regardless of ability to pay.
Another worry is the capacity of civilian providers to treat veterans for service-related conditions such as Agent Orange exposure, Gulf War syndrome, post-traumatic stress disorder and traumatic brain injury. “There can be a lack of understanding of veteran culture and how they can experience something like PTSD differently from other patients,” said Dr. Craig Bryan, director of the National Center for Veterans Studies at the University of Utah. “This could lead many servicemen who seek care to drop out of treatment prematurely.”
But Terri Tanielian, a senior social research analyst at RAND Corp. who specializes in military and veterans health policy, said treating service-related conditions should be no different from handling other less common injuries and diseases.
The response from veterans organizations to the Obama administration's expansion of care in private facilities has been mixed. “If implemented properly, and assuming the management at the VA medical-center level in the field do what they have been instructed to do by VA central office, this could certainly help alleviate some of the access concerns,” said Carl Blake, acting associate executive director of government relations at Paralyzed Veterans of America.
Others, though, said the policy does not fully address the challenges veterans face getting access to care. “The fact is, private care has waiting lists, too,” said Joe Davis, public affairs director for Veterans of Foreign Wars. “You just don't hear about them because civilian hospitals either don't track or don't report them. When was the last time you had or ever had a same-day appointment?”
Follow Virgil Dickson on Twitter: @MHVDickson