In the best case scenario, hospitals “are getting 20% less than the lowest workman’s comp fee schedule in the country,” says Zachary Schultz of EnableComp.
Veterans are seeking care outside of traditional Veterans Affairs facilities as the population of those who served in the U.S. military grows due to a decade of foreign service, according to Zachary Schultz, senior director of Product Policy and Solutions at EnableComp.
Around 2018, the Department of Veterans Affairs wanted to make sure veterans had access to care, he said. Pre-2018, the VA had a couple of programs available for veterans to be treated outside of brick-and-mortar VA facilities, but there wasn’t a ton of funding.
However, the VA MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act of 2018 expanded resources by creating a national Community Care Network that allows eligible veterans to get care from private physicians.
The challenge is the administrative burden and financial strain this puts on hospitals that voluntarily enroll in the network. This is a government payer that requires documentation and pays less than Medicare, according to Schultz.
In the best-case scenario, he said, hospitals “are getting 20% less than the lowest workman’s comp fee schedule in the country. Working VA claims isn’t the most valuable.”
Hospitals get about 50% more money working a commercial claim than a VA claim, he said. Yet, they do it.
For more, please listen to Schultz’s conversation with Susan Morse, executive editor of Healthcare Finance News.
Talking Points:
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Military payers include TRICARE and CHAMPVA
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Veterans seek care outside of traditional VA facilities due to distance, based on drive times, not miles
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Reasons also include VA wait times and specialty services not available at a VA facility
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On wait times, after 14 days, a veteran may see a physician outside of the VA
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Hospitals don’t have a lot of agency when it comes to the steps they must take to document veteran treatment
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VA claims don’t pay a lot but many hospital missions include a level of community service
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On a business level, patient traffic has value for hospitals, even as more volume doesn’t always mean more profitability
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EnableComp advises its partners on steps to take before treatment
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Hospitals need to understand the front end, understand the military payers and nuances, build relationships with the local demographic and leverage technology
More About this Episode:
VA announces VHA reorg as Congress proposes to reauthorize department
VA issues RFP to boost its community care program
The VA is funding more than 200 studies of various AI applications
Community care data missing from veterans’ medical records, says VA OIG
VA Chief AI Officer: Technology is secondary to human problem-solving
Email the writer: [email protected]
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