My husband and I are among the stakeholders of the Veterans Affairs Roseburg Healthcare System. Full disclosure: I am a disabled veteran and retired VA employee married to a 100 percent disabled veteran who receives his care at the VARHS. Recent events caught our attention.
During a press conference held by the VARHS, Director Carol Bogedain explained the decision to close the intensive care unit was made before she or Chief of Staff Chip Taylor came to Roseburg. True. Neither of them had any part in making that decision. Unfortunately, they have been placed in the position of having to support prior decisions made by the VISN (the regional office) and the VA Central Office in Washington, D.C. They have my sympathy. This might explain why Bogedain is taking the push by local veterans for an ICU so personally. It is not meant to be personal. We are aware of when the decisions were made and by whom.
We are also aware that when the decisions were made, the ICU census was low because patients were being diverted to Mercy Medical Center or other hospitals. There were broken beds in the ICU and inpatient ward. They lacked staff to tend to patients in workable beds. Without staff and beds, they couldn’t accept patients. The staff wasn’t replaced and the beds couldn’t be fixed or replaced due to budget shortfalls. Current and former employees can verify this. It appears that neither the VISN nor Central Office was or is willing to look into this.
Taylor has tried to prove to veterans it isn’t safe for them to have an ICU at this facility. We all know statistics can be made to show just about anything. Taylor provided studies that show ICUs that care for more patients have better outcomes.
Taylor also spoke of the importance of having skilled medical staff in an ICU. No one argues with that, but it is directly related to why veterans want an ICU at the VA facility. Veterans believe that VA medical personnel have a better understanding of and more experience with unique ailments of veterans, especially post-traumatic stress disorder. Latest findings indicate a high percentage of veterans, male and female, suffer from PTSD. Symptoms get worse in stressful situations and a veteran in need of ICU care is under stress.
Bogedain and Taylor insist that closing the ICU isn’t about money. They are wrong. It is about money. Bogedain, with her years of service in the VA, should understand this. Perhaps Taylor, who is new to the VA, doesn’t nor does the general public. I will attempt a simple explanation.
Many veterans cannot obtain health care services from the VA. The VA classifies veterans into about eight categories. To reduce the budget, the VA restricted eligible veterans to the top few categories comprising basically two groups of veterans: those who fall below the Housing and Urban Development poverty level for the area and those with service-connected disabilities.
Within those two groups are those with no insurance, some with insurance and those with varying levels of service-connected disabilities. Most of these will have co-pays for services and/or medication except for treatment for service-connected disabilities.
Those with a 60 percent or higher disability rating receive most services and medication at no cost. The co-pays are generally less than those charged by Medicare, especially for medications. When a veteran has to utilize ICU or inpatient services at a VA hospital, it is less expensive or at no cost. When a veteran has to go to a civilian hospital, the VA does not always pay the bill and when it is paid, it is often only after the patient has received threatening billing from the civilian hospital.
But that brings up another problem. Because of its classification Mercy can only bill Medicare/Medicaid a standard amount that is usually less than what it actually costs to provide care for a patient. That’s bad enough, but the VA reimbursement rate is about 75 percent of what Medicare/Medicaid allows. I suspect that’s why Mercy hasn’t jumped up with glee and only accepts VA patients according to the “availability of resources.”
Bogedain maintains that the Douglas County Veteran Forum is being stubborn and unreasonable. Perhaps she doesn’t understand that the forum is a unified effort of all veterans in the VARHS service area. From this side of the coin, it appears that the VA is being equally stubborn. Several suggestions have been given to the VA that might alleviate the ICU problem, but the VA appears to disregard all of them.
Simone Becker of Roseburg retired in 2009 after working for various federal agencies for 26 years, the last 10 at the Roseburg Veterans Affairs Medical Center. Her last position was secretary to the associate director. She can be reached at firstname.lastname@example.org.