The Roseburg Veterans Affairs Medical Center, along with VAs across the nation, rolled out their new program this month for veterans seeking care from private doctors outside the VA system.
The VA Mission Act took effect June 6, simultaneously bringing its predecessor, the Choice program, to an end. The VA hopes the Mission Act will be simpler than Choice, making it easier for veterans to receive care from private doctors and for those doctors to get paid for the services they provide. For veterans, the change has raised hopes of better, faster care and fears that it could be the first step on a road toward privatization of VA services.
What’s new under Mission
Under the Mission Act, veterans are eligible for private care if they would have to wait too long or drive too far to get that care at the VA. That was true of the Choice program, too, but the Mission Act makes it easier to qualify. A patient with a 30-minute drive time or 20-day wait for primary or mental health care could seek outside care under the new act. So could a patient with a 60-minute drive or 28-day wait for specialty care. Drive times take into account not just the distance but the typical traffic for the route.
Under the Choice program, the drive was measured in miles instead of minutes, and veterans had to live more than 40 miles from the nearest VA facility with a primary care provider to qualify. The Choice program also set a higher maximum appointment wait time, at 30 days.
Some veterans will be eligible to be grandfathered in to keep the Choice program until June 2020, if they meet specific conditions.
There are also some additional ways for Roseburg VA patients to qualify for Mission. If the service they need isn’t provided at any VA, or if the local VA doesn’t meet the VA’s own quality standards for performance of the procedure they need, or if the doctor and veteran agree it’s in the veteran’s best medical interest to see a private provider — if, for example, the VA’s oncologist is inexperienced in treating the type of cancer the patient has.
Another important change under Mission is a new urgent care benefit, under which patients in need of immediate, non-emergency care can obtain it in the community and have it paid for by the VA. Many veteran patients will have a co-pay for this service, and they must be eligible for VA care and have been seen by a VA provider or a provider whose services were paid for by the VA within the past 24 months.
All these types of community care must be provided by facilities and doctors who have contracted with the VA to be in the VA’s network. The VA won’t foot the bill for an out-of-network doctor. Veterans must receive prior authorization from the VA before seeking outside care, except for urgent or emergency care. The emergency care benefit remains the same, with the patient needing to provide the VA notice within 72 hours in order to get the bill paid.
Office of Community Care Director Rocky Phillips said the number of in-network doctors is growing, with 11,379 providers across Oregon and Northern California and urgent care facilities in Brookings, Grants Pass, Medford and Lebanon. The VA expects to have at least one urgent care in-network in most urban centers in Southwest Oregon within the next month or so, he said.
The Mission Act also offers a new pharmacy benefit, with veterans eligible to fill a 14-day supply of medication for urgent or emergency conditions at ExpressScripts pharmacies.
Veterans can find participating doctors, urgent care facilities and pharmacies at www.va.gov/find-locations/.
Hopes for improvement
Douglas County Veterans Forum President Larry Hill is hopeful that Mission will work better for veterans than Choice did. Choice, he said, was poorly implemented in part due to bad communication between the VA and TriWest, the company that processed the claims and made the payments.
“It was just absolutely terrible. It improved with age but not that much to where you could really trust them,” Hill said. “There were all kinds of bill pay problems at the time. And there were folks being chased by bill collectors from hospitals. Doctors were refusing to accept patients. So there were a whole bunch of negatives.”
Hill’s a bit worried that TriWest is still going to be administering bill payment under Mission. However, he credited the VA for making more effort to explain this new program to veterans, including a series of town hall meetings.
“They’re trying this time to come out and explain things more fully, the nuances of the program, who’s eligible, here’s how you do it,” he said.
Phillips said TriWest currently serves as the Third Party Administrator, which means they provide the network of private providers, make the appointments and pay the claims. In December, a new contract will be awarded for what’s called the Community Care Network. That contract will shift much of that responsibility back to the local VA.
Who will approve care under Mission depends upon the category of the patient’s eligibility. A primary care doctor would determine whether it would be in the patient’s best interests to obtain private care. A scheduling clerk would determine whether the wait is too long.
The VA will also be receiving a new referral software system at the end of the month that Phillips believes will drastically improve processing times.
That’s no small job.
“Last year we coordinated nearly 28,000 episodes of care for approximately 15,000 Veterans and expect that to increase by about 20%” Phillips said.
Already, Phillips said, payments are being made more quickly.
“Recently we have been seeing providers receiving reimbursement in less than 14 days, which is admittedly much faster than what they were being paid under the Choice program,” he said.
Fears of privatization
Karl Tanner, president of the American Federation of Public Employees Local 1042 that represents Roseburg VA employees, said so far VA staff members are just rolling with the new program. Nobody expects to directly lose their jobs despite the likelihood that more veterans will seek care in the community.
However, Tanner believes there’s no doubt the VA is moving toward privatization. Nationwide, it has 49,000 unfilled positions, he said. It has the money to hire people to fill those positions, and it would be cheaper to do that than to send veterans into the community for care, he said.
The only way that makes sense, he said, is if the end goal is to reduce services so veterans are motivated to seek help from private doctors.
“Pretty soon they’re happy out in town. They say we don’t need those types of services at the VA, and you can privatize it,” he said.
In rural areas like Roseburg, though, that scenario would present some additional challenges. Tanner said there are so few private doctors here that they’ll be inundated if large numbers of veterans begin seeking private care.
Tanner said the VA would do better to fill those 49,000 positions with physicians and provide services at VA facilities.
“’Cause we do great care. Our facility does great care. I don’t care how many negatives you hear, we have great care here,” he said.
If the VA continues to lose staff, though, Tanner believes it will be through attrition rather than layoffs.
“There’s no talk of an RIF, which is a reduction in force. There’s no talk of staff members not being able to work here,” he said.
Hill said many veterans, too, are worried this is the first step toward privatizing the VA, but he doesn’t think the VA’s planning for its own demise.
“The one thing that a lot of the guys are absolutely afraid of is this is the beginning of the end, of getting rid of the VA as we know it. That’s the big bugaboo that’s going to be hanging over like a pall. It really will. It’s going to be there until such time as they’re educated,” he said.
Phillips said he recognizes and understand veterans’ fears about privatization.
“As a Veteran myself who receives my healthcare at the VA I am concerned as well with the future of the VA, however I also believe the intent is not to privatize the VA, but instead to expand the capability of the VA to meet the needs of our Veterans by leveraging services both internally and externally with our community resources,” Phillips said in an email.
“Without Mission and the ability to refer Veterans to a specialist in the community, we would simply be unable to meet their healthcare needs. I don’t think anyone wants to go back to Veterans waiting on lists for care,” he said. “The VA Mission Act is a good thing as it brings much improvement to how the VA can deliver care to our Veterans.”
Overall, Phillips said he’s been hearing a lot of positivity from veterans, especially those who used to have to travel to Portland or farther for specialty care. There’s more uncertainty about the urgent care benefit, he said, since it’s brand new and the network is still being developed.
Hill said he’s adopting a wait-and-see attitude about Mission himself, but he expects medical providers to be happier right away while many veterans will need a lot of hand-holding before they’re able to fully accept it.
“I do anticipate it’ll go somewhat smoother than Choice, but there’s going to be a real hesitation on the part of the consumer,” he said.
For more information
Veterans with additional questions can find information online at www.va.gov/communitycare/. Selecting option 6 at 541-440-1000 goes to a national call center where questions can be answered. The Roseburg VA Office of Community Care can be reached at 541-440-1286.
The VA will hold a town hall meeting to discuss the Mission Act at 5 p.m. June 25 at the Roseburg VA Auditorium, 913 NW Garden Valley Blvd., Roseburg.
A new state law clarifies what restraints can be used against students in public education programs.
Gov. Kate Brown signed Senate Bill 963 into law on June 6, which redefined what restraint teachers can use to protect students.
Not a lot will change for most teachers, but the law outlines what exactly restraint is and when teachers can and cannot use physical restraint.
Rick Burton, Roseburg Public Schools’ director of student services, said the most important part is being proactive in meeting students’ first hour needs, such as warmth, touch, nutrition, social interaction, humor, connection and peer acceptance.
“I rarely see a student act out who feels comfortable, confident and competent,” Burton said.
The new law says it’s OK to hold a student’s hand to escort them from one area to another. Teachers can also use intervention “with the minimal exertion of force necessary” to break up fights or protect students from impulsive behavior, such as running in front of a vehicle or climbing unsafe structures.
Redefining what is allowed will help cut down on documentation and notification steps.
Burton now gets a report on any time there is any type of physical contact between a student and teacher.
Burton said the majority of incidents that require room clears— where every student other than the one being disruptive stand up and leave the classroom — occur in Kindergarten through second grade and often in the beginning of the school year. Room clears would be considered seclusions under the new law.
Clearing classrooms is typically handled by the teacher and principal on site, while Burton gets called in if there’s a need for additional assessment or interaction with the parents.
Burton added that one classroom clear can be an indicator of a change at home or bad day, but that by the time a student has been the cause of three classroom clears, there’s a pattern and the district will start work on a safety plan. The new law requires schools to provide an explanation for students who were placed in seclusion or restraint more than 10 times in the course of a school year.
“Having a setback is not a deal breaker,” Burton said. “If the base line is not effective, the district will work on safety plans and with a parents permission we can put together a behavioral support plan.”
Roseburg school district emphasizes conscious discipline, creating a relationship with students through communication and using alternative strategies.
“We expect a lot from children,” Burton said. “There can be incongruencies between home and school. Schools have different rules.”
Although 10 seclusions are rare, it is important for students to be pre-taught the appropriate behavior in a classroom and re-taught throughout the year according to Burton. If it does become a chronic issue a more restrictive placement is an option after all other options, such as child development specialists, school counselors, therapists and psychologists have exhausted options.
“We look at what we’re not doing well,” Burton said. “Not every child is the same.”
All elementary schools have child development specialist on site and the district has a psychologist assigned to each school. Schools will also develop a functional behavior assessment to prevent loss of instruction for the student.
He also noted that at the peak of the meltdown research shows a student only has about 10% of cognitive thinking abilities. “It’s not an effective time to reason. Our main function then is to keep them safe until they are open to communication,” Burton said.
SB 963 was created to add clarity for teachers in how to address those classroom disruptions.
Restraint is classified as using medications or other chemicals to calm a students, using a device to limit their movement, pinning students to the floor or any other solid object, putting pressure on a student’s neck, mouth, throat, genitals, stomach or back, or any action that is designed to inflict pain.
When those forms of restraint take place the school is required to provide written notification within 24 hours. Those notifications have to include a description of the restraint, the date, time, location, names of those involved, what prompted the restraint and what other methods were tried to de-escalate the situation.
The notification will also note whether the teacher was educated in physical restraints. The district provides instruction and training through the Crisis Prevention Institute to assist teacher in protected physical intervention.
Oregon law also mandates a “debriefing meeting” with the parents or guardians take place.
SB 963 received bi-partisan support of 31 legislators, including Sen. Dallas Heard (R—Roseburg), passing 58-1 on the House Floor and 26-4 in the Senate.
In an effort to offset its legal expenses, the Downtown Roseburg Association will pay the City of Roseburg $10,000 less in contract fees this year.
The association pays the city an annual fee to lease and operate downtown parking infrastructure in exchange for keeping all parking-related revenue collected by ParkSmart. Last year, that fee was $47,500.
On Monday, the City Council unanimously approved a new three-year contract and a fee reduction for the first year — the association will pay $37,500 in 2019-20.
Association Executive Director Susie Johnston-Forte says the fee reduction is necessary to financially stabilize the downtown advocacy organization. She attributes the financial problems to unanticipated legal expenses brought on by former director Alyssa McConnel.
In 2018, McConnel filed a complaint to the Oregon Bureau of Labor and Industries, claiming the association fired her in retaliation for protected whistleblowing activities. McConnel alleged the city received kickbacks from the association in exchange for the parking contract. The bureau dismissed the complaint earlier this year for lack of evidence.
When McConnel filed the complaint, the association contacted its insurance company, who hired an attorney, Johnston-Forte wrote in a May 20 letter to Roseburg Community Development Director Stuart Cowie. The association’s deductible was $10,000 — the amount of its fee reduction to the city.
In April, McConnel filed a lawsuit against the association, making the same complaint.
The lawsuit has been “resolved,” Johnston-Forte said Thursday. She declined to elaborate further on the resolution, because “both parties signed a confidentiality agreement,” she said.
McConnel also declined to comment.
The association’s board of directors recently approved a settlement of “less than $50,000,” Johnston-Forte said in her May 20 letter.
“We felt that the distraction of dealing with this lawsuit, if going forward to litigation, would negatively effect, in a seriously detrimental way, the work we are here to do,” she said. “We feel very confident that this matter will be settled soon.”
Johnston-Forte said additional financial assistance from the city won’t be necessary.
Although the City Council approved the new contract and fee reduction unanimously Monday, multiple councilors suggested inconsistent parking regulation enforcement influenced the association’s financial problems.
“There are those who really work hard to park where they’re really not allowed,” Johnston-Forte said, referring to downtown business owners who illegally park in the free parking spaces intended for customers.
City Councilor Brian Prawitz said he thinks the association would be able to cover legal expenses if people who violate the free parking were ticketed consistently.
“The other day it was awesome,” said Prawitz, who owns a downtown business. “Tried to go to lunch at Alexanders (Greek Cuisine), couldn’t find a place anywhere on any street. I was going to park for half an hour, have some lunch, I think that’s legal. But it was packed, and I couldn’t help but think, ‘how many of those spots were occupied by people that work downtown.’
“I want to see the free parking ordinance enforced equally ... I think if it’s consistent, you’ll cover this easily,” Prawitz said.
Johnston-Forte agreed parking enforcement could be enforced better, and she said the association is working to improve it with ParkSmart. But she disagreed that if parking regulations were consistently enforced, the revenue would have covered the association’s legal expenses.
“I think that’s not correct,” Johnston-Forte said. “The fee reduction is really in response to money that we didn’t anticipate having to expend.”
She said the association has moved on from the recent legal problems and is looking to grow its services through several revenue sources.