In the wake of revelations that patients have waited for months to see a primary care doctor at a veterans’ medical center in Phoenix, the Obama administration announced in the past few days some reasonable steps to mitigate the problems. One important measure will move veterans who have been stuck too long up the waiting list. Another will offer those still facing waits of more than 30 days the option of using private hospitals and clinics.
The Department of Veterans Affairs operates a sprawling health care system that includes 152 hospitals or medical centers, 900 clinics and a host of other facilities, including mental health centers. Its doctors have special expertise that many community hospitals might find difficult to match, such as dealing with combat-related post-traumatic stress disorder, exposure to Agent Orange and Gulf War chemicals, and severe spinal cord injuries suffered in combat. Some private hospitals can deal with these issues, others cannot.
In a fact sheet posted Tuesday, the Veterans Affairs Department said it would maximize access to care within the system by extending clinic hours on nights and weekends, paying overtime to health care workers, and beefing up understaffed clinics.
Where the department cannot increase its own capacity, it will expand care at community facilities that are not part of its system. The department already spends about 10 percent of its budget on care outside its system; in fiscal 2013, it spent $4.8 billion caring for more than 1 million veterans in community clinics and hospitals.
The department also promises new administrative procedures to speed things up. Each hospital or clinic will review cancellations on a daily basis and inform long-waiting veterans of any openings. It will try at least three times to contact patients scheduled for appointments more than 30 days out and, where the department can’t accommodate them, will refer them to private facilities.
One problem is that private clinics are themselves often understaffed and straining to meet patient demand while remaining solvent. And some private administrators worry that government payments might not arrive in time to satisfy immediate budget needs.
It is striking that nothing the Veterans Affairs Department is doing is truly new. The policy does not change the circumstances under which care can be provided outside the VA system or who is eligible for it. What’s really changed is that the department is now dedicated, or so it says, to ramping up its own capacities and making it easier for more wait-listed veterans to use private facilities.
This is a smart, if belated, response to a backlog problem that has existed for many years. The deeper problem is that the Veterans Affairs health care system has too few primary care doctors to handle its rapidly growing patient load and finds it difficult to hire more because of its generally low pay scales. There is no way that a doctor in the system can be responsible for the care of 2,000 or more patients, as many now are according to some close observers, without putting those patients at risk of neglect or once-over-lightly care.
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