Ad­min­is­tra­tive and re­im­burse­ment hur­dles ham­per VA ini­tia­tive on pri­vate-care ac­cess

Modern Healthcare - - LATE NEWS - —Vir­gil Dick­son

Ad­min­is­tra­tive and re­im­burse­ment is­sues are hin­der­ing the Vet­er­ans Af­fairs Depart­ment’s new ini­tia­tive aimed at grant­ing wider ac­cess to pri­vate care for vet­er­ans un­able to get treat­ment within the sys­tem, ac­cord­ing to some providers around the coun­try who have tried work­ing with the new pro­gram.

The op­por­tu­nity for more vet­er­ans to seek pri­vate-sec­tor care was made pos­si­ble by a $16 bil­lion vet­er­ans-re­lated mea­sure signed by Pres­i­dent Barack Obama in Au­gust. But as vets have be­gun to re­ceive in­for­ma­tion on how to ac­cess care out­side VA fa­cil­i­ties, providers in some of the most ru­ral re­gions of the U.S. say they’ve ei­ther de­clined to con­tract with the man­aged-care com­pa­nies in­volved in the pro­gram or haven’t been ap­proached.

The VA emer­gency fund­ing law states that “rates ne­go­ti­ated shall not be more than the rates paid … un­der the Medi­care pro­gram.” As a re­sult, the VA pays Medi­care rates to TriWest Health­care Al­liance or HealthNet Fed­eral Ser­vices, the man­aged-care com­pa­nies the depart­ment has con­tracted with to over­see the choice pro­gram. But those com­pa­nies re­im­burse at less than Medi­care rates, prompt­ing some providers to not join the pro­gram.

“We are not con­nected to the ne­go­ti­a­tions they have with lo­cal providers, so we don’t know what they are ac­tu­ally re­im­burs­ing,” a VA spokes­woman said.

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