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Reimbursement levels could restrict the level of aid, even among doctors who want to help

Local physicians asked to take on VA casesThe Hawaii Medical Association, a physicians' advocacy group, is urging private doctors to volunteer to treat veterans to help alleviate a crisis in access to care in the islands.

HMA executive director Dr. Christopher Flanders told the Honolulu Star-­Advertiser that the group voted Tuesday along with the American Medical Association to ask the federal government to use private providers outside the U.S. Department of Veterans Affairs health care system "until the VA can provide health care in a timely fashion."

A Veterans Health Administration audit released Monday shows that Hono­lulu veterans experienced the worst wait-time average in the entire system — 145 days — to get their first appointment with a primary care physician.

The association plans to create an online registry of HMA's 400 private physicians willing to care for veterans to help solve the significant backlog problem, at least temporarily.

"I think it has reached crisis level," Flanders said. "The VA has had problems for a long time. It just hasn't gotten the attention that it deserved. A lot of our doctors are saturated, but if we call on their altruism, we're hoping it'll get our doctors to step forward. It may work as a stopgap until the VA can get things back in shape."

Flanders said he hopes to have a registry system in place within the next couple of weeks with the VA, which covers service-associated injuries and conditions.

But getting Hawaii physicians to participate may be problematic as many are already overloaded and burdened with low reimbursements from government payers such as Medicare and Medicaid.

"I think most doctors really do want to take care of vets. The difficulty is going to be whether we can afford to provide services for the level of reimbursements," said internist Dr. Dan Davis of the Queen's Medical Center. "Where each individual practice is going to land probably depends on how busy they are and how they're doing financially. If a practice is doing really well financially, they can afford to take lower fees for a certain segment of the patient population. If they're not doing well financially — and many doctors in Hawaii are not — then they simply can't afford to take on patients that they will see at a loss."

Dr. Stephen Kemble, a clinical assistant professor at the University of Hawaii John A. Burns School of Medicine, said Hawaii has a shortage of doctors, specifically in primary care, so the capacity in the community to absorb VA patients is limited.

"It's not going to be adequate. But I do think that most doctors would want to help," he said. "They might not be able to open their doors wide, but many doctors would be willing to take at least a few VA patients to help out."

In general, the VA pays providers on the "low side," similar to reimbursements from Medicaid, the government health insurance program for low-income residents, Flanders said. Many Hawaii doctors say that government reimbursements do not cover the cost of care and have stopped taking Medicaid patients altogether.

Hawaii VA spokeswoman Patricia Matthews didn't respond to requests for comment.

The VA's Pacific Islands Health Care System serves an estimated 129,000 veterans throughout the Pacific.

"The payment is a little bit of an issue and my feeling about that is we'll cross that bridge when we get to it," Flanders said.

"We'll get the care taken care of first — that's the primary concern. We're doing this in good faith. We're really not asking for anything extraordinary in return. This is a good-faith effort to help them out while they're in trouble."

Congress is considering legislation that would allow veterans to get care outside the VA system. The measure, named the Veterans Choice Act, would allow veterans who live far from VA facilities or are on a long waitlist for an appointment the option of seeing a private provider.

The VA spent roughly $4.8 billion, or about one-tenth of its health care costs, in 2013 on private care for veterans who live far from VA facilities or those in need of care unavailable in the VA system, according to the Los Angeles Times.

Monday's findings follow accusations of gross mismanagement at VA centers across the country that led to the resignation in May of Hawaii-born war hero Eric Shinseki as VA secretary.

The VA audit found that more than 57,000 veterans are still awaiting their first medical appointment at VA facilities.

"The AMA believes that all Americans should have access to health care, especially those who bravely serve our country," incoming AMA President Robert Wah said in a statement. "Our nation's physicians can and should be a part of the solution to this national crisis to ensure America's veterans get access to the care they need and deserve."


Source: Star-Advertiser

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