Tuesday, June 23, 2015


We are at a point wherein competence does not matter.  At the VA you just do as you please and you cannot be fired.  Again the problem is not the doctors - it is on the administrative side.

Some numbnut who knows nothing about VA care wrote a regulation which says the VA will only pay for outside services which are also covered by Medicare.  Well here is a shocker - the VA by law must by provided all needed care, whereas Medicare must only provide the care approved by Medicare.

The VA in Harlingen, and probably the entire country, was unaware of the regulation change and continued to send veterans for services not provided by the VA to private doctors who accept VA vouchers.  In the case of services which are not covered by Medicare, even though the VA Harlingen issued the vouchers to the doctors saying they will be paid, because it was a violation of the regulation, the VA will not now pay the doctors.

Here is the real kicker - the doctors have few option in terms of going after the VA for payment because the VA is basically not bound by a voucher for unauthorized services.  But by the same voucher which the VA says it will not honor, the doctors by law cannot go after the veteran for payment.

Now there is only a handful of care options Medicare does not cover.  But for now, because some paper pusher and number cruncher who did not understand Medicare does not cover all medical services, veterans who are entitled to 100% medical care [not all veterans get 100% medical coverage - it is a very complex system based on service connected disability and income- and co-pays for services and medications - yes many of us pay co-pays based on income level] are now being told they are on indefinite hold until someone in Washington fixes the problem, or releases funding to pay all of the doctors who are now unpaid.


Yesterday because the person assigned to coordinating my gallbladder surgery was unwilling to do her job - not the first time for this person - I had to fax over to the McAllen surgeon all of my VA and original surgeon of choice medical records and referral.  She had everything, but she claimed she did not know how to access them and then fax them to the surgeon in McAllen.  I get copies of everything so I had them and faxed them over.

Now we wait - the VA will not schedule the appointment until the new surgeon reviews everything and decides how fast he will see me.  Based on last nights fever and pain I am going to end up doing this the worse possible way - going by ambulance to Valley Baptist and then pray that my original surgeon of choice will agree to do the surgery at VB even though he has already told me there are no surgeons in Brownsville qualified to do the surgery. The option is to wait for the gallbladder to rupture which will then make it a lot worse for everyone, or go to the ER when I can no longer stand the fever or pain and hope my original surgeon of choice will do the surgery even though he believes the liver complications put the surgery outside his skill set.  Trust I appreciate his honesty.  There are brilliant surgeons who cannot do everything - and since it is incredibly rare a person needs their gallbladder out twice - I understand why he prefers a specialist in liver surgery.


As I am editing this the liver surgeon's office called and he will see me on Friday.


Anonymous said...

Good to hear and sorry to hear the VA is only getting worse not better.

BobbyWC said...

But please remember the doctors are top of the line. The problem is you cannot work all day a full patient load, and then have to review all lab work, scans, x-rays done in house, and all medical records sent from outside specialists, while also processing non-formulary medications - this means medications which must be approved at a higher lever - there is also second level non-formulary which requires approval at even a higher lever - it takes a lot of work for the doctor to document why these non-formulary medications must be approved.

Then on top of all of that the doctors must request outside vouchers for services not available at the VA Harlingen - these doctors are working 70 hours a week.

The patient hours should be 10-3 with only enough appointments to fill those hours - no endless overbooking - they need time in the morning to review reports from internal and outside testing so they can act accordingly. They need time in the afternoon to complete new paperwork.

They need two walk in doctors - they can be PA's or nurse practitioners - A lot of times a PA or nurse practitioner can move the veteran along real fast thereby relieving the doctor of having to see the veteran.

But know the problem is not with the doctors - it is on the administrative side and Congress which believes endless Hearings will solve the problem - no they will not - The President needs to tell the VA Secretary to deal with the problems or resign. The VA Secretary needs to be able to go to the president and say these are our medical staff shortages - we need to raise wages and start a national campaign to recruit doctors - they need to be aggressive - we know the problem - it is time to stop having Hearings and start fixing the problem

Bobby WC

Anonymous said...

I know it is not the doctors but hoops you have to jump through to get services. Or the endless wait for someone to review something.