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“We treat our veterans like they are at the bottom of the list, and it’s not right. I want them to know they can have a physician in their own location and get treated quickly and be on their way to getting better.”


patient visits grew 72 percent nationally, with 1 million veterans receiving outside care in 2013. At press time, organized medicine officials said VA had yet to work out the specifics of how it would negotiate agreements with private physicians in light of the new legislation. Before its passage, TMA officials


spoke with the VA Heart of Texas Health Care Network to explore various options. The other two Texas VA networks have not reached out to TMA. Dr. Lockhart says some non-VA con- tracts, for example, are local agreements with a single physician or clinic, and physicians who sign up on TMA’s regis- try could be included in a VA rotation list for referrals for a particular specialty. Other contracts, known as Proj-


many efficiency steps. At some point you just need more providers.”


Finding a fix


On July 31, just one day before the Au- gust recess, Congress passed the Veter- ans Access, Choice, and Accountability Act of 2014, which calls for system-wide administrative improvements and in- creased transparency within VA. In ad- dition to more money for VA to hire in-house medical staff, the measure includes an expansion of VA’s ability to contract with private physicians and oth- ers, for three years or until appropriated funds run out. The bill allows veterans to seek outside care from Medicare-en- rolled doctors when waiting times at VA facilities grow beyond 30 days, or if vet- erans live more than 40 miles from the nearest VA facility. Other provisions call for systems to ensure prompt payment for VA and non-VA care. VA also “would be expected to seek payment rates for providers of contracted care (such as doctors and hospitals) equal to Medi- care’s rates, but the department would be authorized to negotiate higher rates


36 TEXAS MEDICINE September 2014


under certain circumstances,” according to the Congressional Budget Office. In the meantime, the Veterans Health


Administration in May had launched the Accelerating Access to Care Initia- tive, giving VA more “flexibility” to use outside referrals, according to a VA fact sheet.


AMA praised Congress for taking ac-


tion, and the association supported the legislation “because it is an important step to connecting veterans with phy- sicians who can help them right now,” President Robert M. Wah, MD, said. “All Americans should have timely access to health care, especially those who bravely serve our country. Our nation’s physi- cians can and should be a part of the so- lution to ensure America’s veterans can access the care they need and deserve.” VA currently spends about $4 billion a year — 9 percent to 10 percent of the VA’s budget — on contracts for non-VA care. Dr. Jones told Texas Medicine that figure is about $280 million for the re- gion he oversees in Texas. The need is apparently growing: From 2008 to 2013, non-VA care out-


ect ARCH (Access Received Closer to Home) — which the new legislation reauthorized — and PC3 (Patient-Cen- tered Community Care), operate more like commercial networks of physicians and other health care professionals and facilities in multiple locations, and phy- sicians could join the regional network, TriWest. Still other agreements are for more specific locum tenens services. Texas VA representatives identified a number of specialty areas in critical need, including dermatology, ophthal- mology, orthopedics, gastroenterology (colonoscopies in particular), urology, neurology, and nonmedical services such as physical therapy and audiology. The need also varies regionally, Dr. Jones says. For example, VA uses more con- tract care in the Rio Grande Valley where there is no VA hospital. VA does have “some outreach for pri-


mary care, especially in rural areas and occasionally in certain urban areas,” he added. But the system mostly outsources for specialty care and takes careful con- sideration of veterans’ needs when it comes to specialized services best han- dled within VA, such as mental health and combat-related treatment. Still, Dr. Lockhart encourages physi- cians of all specialties to sign up. “Just because they [VA] don’t have the need [for a particular specialty] today doesn’t mean they won’t have the need tomor- row,” he said.


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