Hitting a wall To bolster that recruitment, however, TMA leaders emphasize the need for a seamless, transparent, and reliable sys- tem for physicians when it comes to ad- ministrative requirements and payments. Dr. Lockhart says TMA emphasized
to VA officials that any contracted care include such assurances. Dr. King’s letter to President Obama also requested that any private-sector option “include an ef- fective and rapid payment system for the private-sector physicians who step up to provide care” and that any emergency intervention “be continued until timely transition of care can safely be handed off to the VA.”
One idea behind the new legislation’s
use of Medicare physicians for outside care was that existing Medicare systems could help facilitate and speed up cre- dentialing and payments. TMA’s Payment Advocacy Department
has received complaints from physicians about months-long delays in VA claims payments, as well as incorrect payments. If your practice has experienced out- standing VA claims, send documentation to TMA’s Hassle Factor Log program at
www.texmed.org/hassle. In addition to prompt payment provi- sions, the new legislation calls for a U.S. Government Accountability Office audit of the timeliness of non-VA payments one year after the bill’s enactment. A March GAO report reveals administrative shortfalls have in the past led to inap- propriate claims denials. Read the report at
www.gao.gov/assets/670/661404.pdf. Dr. Lockhart says some of the pay- ment and administrative problems may stem from the fragmented VA structure within Texas, managed by various re- gional networks and budgets. While Dr. Holcomb praised VA’s
outreach for specialty care, he also ex- pressed concern about the gaps in pri- mary care. “If you’re in the system, you have a considerable amount of benefits avail- able,” such as full coverage of medica- tions, he said. “The gap is getting in the door. Getting that first contact with a primary care provider is the problem.” When he does see veteran patients, Dr. Holcomb often hits a wall when try-
ing to communicate with the VA system. “We see them in the hospital and take
care of them. But we can’t get records from the VA, so we don’t know what [treatment] happened to them over there. We can’t transfer them to the VA. And we never get paid. I wouldn’t even know how to send the bill,” he said. “The only way I’m able to reliably get their records is to say, ‘You have to go over to the VA and sit in the triage area as long as it takes and have them deliver your medical record to you.’ ” Baylor Scott & White Health (BSWH)
has reached out to the Temple VA to provide additional help, despite hav- ing trouble breaking through the same barricades, says Chief Health Policy Of- ficer and former TMA President J. James Rohack, MD.
Even though BSWH and VA both use
electronic health records (EHRs), the cardiologist can neither retrieve nor send patient records electronically. Nor can he e-prescribe into the VA system. Dr. Rohack has to handwrite a prescription
and fax it in and send medical records the same way. That also means he runs the risk of unnecessarily repeating tests or procedures because he can’t easily see what tests VA has done. “Veterans give up part of their lives to
serve our country, and this is one way we [physicians] can give back,” Dr. Ro- hack said. “But it does highlight some of the challenges we have when veterans leave the VA system and go to the pri- vate sector. So there’s a recognition that this congressional legislation shouldn’t be considered a solution to the problem. It’s a patch that needs more thoughtful, long-term discussion on the future of the VA health system.” Some congressional members who opposed the legislation expressed con- cern that it did not fully address the underlying problems at VA, especially given the high price tag.
Making strides Region 17’s Dr. Jones acknowledges cer- tain shortcomings but says some of them
Map of Texas VA regions Reg. 18 Reg. 17 Reg. 16
September 2014 TEXAS MEDICINE 37
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