New Roseburg Veterans Affairs Medical Center Director Keith Allen held his first town hall in Roseburg Tuesday, and he got an earful from veterans about his proposal to convert the emergency room to an urgent care.
Veterans voiced concerns Tuesday about where emergency care will be received and how ER bills will be paid. Veterans also heard from Roseburg VA Office of Community Care Director Rocky Phillips about changes to the way veterans receive non-emergency health care from private doctors. The VA shifted away from its former Choice program to the Mission Act earlier this month.
Several veterans said they’d had trouble getting the VA to pay when they went to Mercy Medical Center for emergency care.
Phillips said the VA can’t guarantee payment unless veterans come to the VA first for authorization, but he said in the case of an emergency they should still go to Mercy first.
One woman said a year and a half or two years ago, her husband had COPD and she couldn’t keep his oxygen up to safe levels. She said the ER at the VA refused him admission because he was in an ambulance, so he was taken to Mercy. She said she received bills for six months or more from Mercy and had to keep asking them to accept small payments and begging them not to hurt her credit rating. She said the VA did eventually pay. No sooner had that been done that she received a bill from the ambulance company, she said, and the process started all over again.
“This is an issue. These people in here cannot, I don’t, have the money to pay a $3,000 ambulance ride or a $25,000 hospital visit,” she said. She said veterans’ families should not have to worry about the bills for an emergency weeks and months afterward.
She also asked now there’s the Mission Act, what happens if a veteran thinks he’s having a heart attack and goes to Mercy, only to be told it was heartburn.
“I just don’t see how anything’s changed from the way it was,” the woman said.
Phillips said the Mission Act doesn’t change anything about the way emergency care bills are paid. He said payment decisions are made by the regional VA office, which bases its decision on what a prudent layperson would do.
A man said a friend of his who served four tours in Vietnam and had chest pains and difficulty breathing received a denial of payment for going to a private hospital. He said he had other veteran friends who had received similar denials and asked what it would take to change that.
Allen said it takes Congress to change the law.
Another man expressed frustration about the VA being unable to address an emergency like a heart attack or stroke.
“The longer I listen to you the more frustrated I’m getting,” the man said. “Because I don’t know why you’re here. If you can’t provide the services that we need, what the hell do we need you for.”
Other veterans, however, praised the quality of care they’d received at the VA and said VA doctors care more about them than doctors in private care.
Phillips said he has dealt with the frustration over bill payments himself.
“We must, by our job, implement the law. We can’t change it, unfortunately. I agree it’s ridiculous, but I personally cannot change that law,” he said.
On the idea of downgrading the ER, Allen said it makes more sense to offer urgent care than emergency care at the VA. Allen told the veterans that 89 percent of patients who come to the emergency department are actually there for urgent care level concerns. He said that emergency physicians don’t want to work at the Roseburg VA because they can’t keep their skills up and they don’t have the backup services like labs and imaging that they need.
Allen said while the Mission Act hasn’t changed anything about the way emergency care at outside hospitals is covered, it has given veterans a new urgent care benefit. The VA hasn’t yet been able to find a private urgent care facility in Roseburg that will contract with the VA.
Phillips said the Mission Act strives to make it easier for veterans to access health care from non-VA doctors in the community. It doesn’t solve every problem, he said, but it is an improvement.
“It’s the next step in the evolution of the program as we move forward. It’s come a long way in the last five years from where we used to have veterans waiting on wait lists, waiting for care,” he said.
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. Under Mission, 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.
Phillips also said the Mission Act has made it quicker for the VA to reimburse private providers, which he said is now being done within 15 days.
Mission also allows veterans to seek outside care for services the VA doesn’t provide, or services for which it doesn’t meet quality standards. And they could seek outside care if their VA doctor determines that’s what’s in their best medical interest.
He said no veteran is required to use the Mission Act. Veterans who would be eligible but are willing to wait longer or drive farther for services still have the option of receiving their care from the VA, rather than from private providers.