Sorry, I spent the long weekend in Mexico and I haven't had much time to screw around online. I'm going to take this piece by piece. My role at the Phoenix VA officially is in healthcare compliance (GS-11), however I am currently detailed to another position in NonVA Care (GS-12). Both roles are administrative in nature.
They were saying that the VA hospital is one of the most efficient hospitals ever known. That 95% of funding goes directly to patient care, while only 5% goes to administration funding.
What? First off, this argument requires definitions. Define efficiency, administration, patient care and which VAMC? There are only around 140 of them and no two are exactly alike. All serve a population of varying size, demographic, region and complexity. Once we get a baseline on this, we can really talk, but for now lets assume he is going by layman's definitions. I am not a clinician and neither are the 47 people that work for me so it might be safe to say that 100% of our time is administrative. My current role however is to oversee the processing of authorizations for patient care from local private providers. My supervisor on the other hand, is a board certified, primary care physician. He is supposed to have a small panel of patients that theoretically take up half his time. He has seen exactly zero patients in the past year. His time is split between helping me run my section, as I often require a doctor to talk to another doctor to get things done, and authorizing urgent consults. Essentially, he goes to meetings, reads and signs consults for 12 hours a day, but paid for 8. This is why I immediately object to the 95% number. While my role and my boss' are objectively administrative, both directly affect patient care. Similarly, most VA doctors spend several hours a day documenting their clinical interactions. In the private sector this is also done but it is used to drive billing. This is non-clinical work but without it patient care can be affected. Unless he has some sort of citation to these numbers, I call bulls___. There is never black or white in government, only gray.
This is in stark contrast to most every other hospital where typically 20-30% of funding goes to administration and the remaining goes towards the patient.
True. There are numerous studies that suggest part of the reason Americans pay more for healthcare is the administrative structure thats in place in private hospitals. This administration however, is mostly due to regulatory compliance, coding, billing--in essence legally getting paid for services rendered. In a European-style system there is exactly one source of funding, the state. With exactly one process, as defined by the state, to get paid; therefore fewer administrative professionals are required to specialize in this process. Here in America there are dozens of government and private payers, each with its own process and its own documentation requirements. Thanks to HIPPA, they at least all use the same forms.
The administrative burden to adapt to multiple payers is reflected in the overall cost of doing business. This is similar to an airline's cost for fuel being baked in to the cost of your ticket. If the ticket doesn't have enough value to justify the cost you will find another airline, or just drive. The airline will either adapt, or go under. Southwest, Jet Blue, FEDEX and the US Air Force all pay the same for fuel, and all can transport passengers in varying degrees of comfort.
The VA by the way, also bills private insurers for copays for non-service connected care but most VA hospitals aren't very good at it.
They continued to say that America has a bad habit of when we have a war happen, everyone talks about cutting money for the war effort and the number one place we go to is to cut funding from the VA.
I think your professor may be conflating the VA with DOD, but I'll assume he knows the difference. I'd point out the VA has congressional liaisons whose job it is to provide estimates on the potential costs for our foreign policy adventures. Potential VA costs have also been used as consideration for several DOD programs, many of which are public health related (smoking cessation programs for example). I would argue that Congress at least recently has been smart enough to see the causal link between the two departments.
They said that the reason this happens is because the VA is so efficient in taking care of our vets that it is one of the few places that can still manage to stay afloat after such funding cuts.
Congress also provides us the criteria which we can pick and choose our patients based on service connection. I will defer to Bud to elaborate on that. I would argue that this "fiscal solvency" in the past has been the result in political decision making. For example, the VA by law will provide care for any WW1 Veteran, any alive that is, for any condition at no cost to them or their families. That has been on the books for nearly a century. Contrast this with the decades it took to recognize Agent Orange exposure or Camp Lejune, etc.
A year of chemotherapy for many of these Veterans costs an average of six figures in a VAMC. Double that number if I have to authorize it under the Choice act. Imagine how much we would have saved if Congress recognized it back in the 80s and we were able to treat these guys sooner.
Plus, the VA is not affected by EMTALA, something no private health system can avoid.
They said that it is preposterous that we have a war to fight, so we cut funding from the one place expected to care for our vets and that we have no forethought to if they will need medical or psychological care when they come back.
Damn straight. That is preposterous.
My professor said that we have continued this political line of thought as recently as 2003 when we did the last big funding cut from our VA.
Any chance this guy ever heard of the Veteran's Choice Act?
https://veterans.house.gov/the-veterans-access-choice-and-accountability-act-of-2014-highlightsOr is he aware that OIF/OEF are eligible for care for five years past their date of separation regardless of Service Connection?
http://www.oefoif.va.gov/healthcare.aspWe're throwing plenty of money at VA, we're aren't any good at spending it.
Oh, and as recently as 2003? Over a decade and seven elections ago? I love people like this. They always pick the sweetest cherries.
Then my professor went on to criticise legislation. I am not sure which senate bill, but they said there is a misleading bill named the "care for our vets" bill or something that wishes to cut funding from our VA hospitals under the ruse of helping the vets, and will only seek to line the pockets of the 1% of private practice offices and private physicians.
In summary they were saying that private healthcare providers would not reduce wait times, cost, nor improve the care that our veterans get and that to think so was faulty ideology.
Wait times? This assumes evidence not in existence. No, seriously. The only reason the VA measures such things is because we have to. Private hospitals typically don't. Why? Paying for the cost of operations requires treating patients. If they can't get patients into beds, they go under--kind of like when airlines have no passengers.
The cost of healthcare by the way, is driven independently of the VA, private hospitals and those evil monocle wearing capitalists at insurance companies. It is driven primarily by CMS and the AMA in the form of Medicare Reimbursement rates (price floor). Surely, a college professor would understand how that works and wouldn't need it explained.
The bill they referenced might have been this one, but I am not sure:
http://www.mccain.senate.gov/public/index.cfm/2016/4/senators-mccain-ayotte-cornyn-cruz-ernst-flake-graham-tillis-introduce-the-care-veterans-deserve-act
Pass it first. Then we'll talk.
louie the lumberjack
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