The Department of Veterans Affairs may soon reimburse veterans for the travel expenses for receiving care at a VA medical center outside their region as an alternative to paying for local but more expensive private providers.
The VA is considering the rule changes to try and curb the rising costs associated with sending veterans to private providers, which the General Accountability Office says climbed from $3 billion in 2008 to nearly $4.5 billion last year. The rule change would only authorize reimbursement if it is more cost-effective but equal to what they’d get by being referred to a private medical provider closer to home.
In part the VA medical centers are incurring higher costs for fee-based private medical providers to keep the veteran from paying out of his own pocket for travel costs to another VA hospital. Under current rules a VA medical center may only cover travel reimbursement for veterans with at least a 30 percent service-connected disability rating or an annual income below a specific level.
"Officials . . . told us they often send veterans who are not eligible for travel reimbursement to fee basis providers instead of referring them to other VAMCs that can provide the care because VA cannot compensate them for their travel to another VA facility," the GAO reviewers said.
The hospitals are not even allowed to consider the cost effectiveness of paying veterans’ travel costs in order to keep their care within VA facilities.
In one example cited by the GAO, the VA Medical Center in Biloxi, Miss. has at times incurred additional costs of between $30,000 and $40,000 to refer a cardiac patient to a private, fee-basis provider in the region because the veteran did not qualify for reimbursement if he traveled to the Houston VAMC.
At other times, VA regional hospitals will refer veterans to private providers to make sure the veteran is seen within the wait-times set by the Department of Veterans Affairs. The Alexandria, Va., VA Medical Center often refers veterans to fee-basis specialists in audiology, cardiology and ophthalmology.
The problem is that the VA has not tracked how long it takes for veterans to be seen by the private providers, so the agency does not really know if the goals are being met, according to the GAO.
The VA, in its response to the findings, said its business office is already at work building a national wait-time indicator for measuring the performance of fee-based providers, and expects to have it completed in September.