The VA Obstructs Again

Our hospital used to have a contract with the local VA. Sick patients who came here would be covered under VA benefits. Not anymore.

Unstable patients stay. The second they are stable, they "ship" to the inpatient VA hospital in our state.

Only problem is, those with Medicare or other payer sources frequently say, HELL NO. I ain't goin'.

It essentially becomes a cost shift from the VA roles to the Medicare roles.

Irrespective, these vets always want their new meds on discharge to be covered by the VA.

Only problem is, I don't work at the VA. And my script don't mean Jack to the VA pharmacists.

I can't fill a VA prescription for the patient.

And our local VA docs have all lost privileges to my hospital, so they can't come here because they don't carry malpractice insurance outside the VA system anymore.

So this is what the VA has created for their patient. A system of road blocks.

Sunday afternoon today . Monday holiday. MLK day, which of course, the federal govt shuts down for.

I need a follow up appointment. I need lab drawn. And I need prescriptions filled for my VA patient who doctors in the VA exclusively. This is the response I got.

I get a call back from the VA stating that none of the local docs are on call. None are taking calls for any of their patients. All calls are diverted to the emergency room physician at the VA in the other town, one hour away. My patient lives one hour in the other direction, opposite the VA.

I kindly ask the secretary on the phone how I am supposed to get follow up lab set up, an appointment, and prescriptions filled for my patient who just had a GI bleed, needs stomach medicine, needs a follow up INR and an appointment in a week.

The response? He can drive to the VA, 3 hours out of his way to see the ER doc at the VA hospital who will not enter any orders without seeing the patient first.

Unacceptable I say. I will not send my patient on a three hour round trip drive just to get routine labs entered, a followup appointment and heart burn medicine ordered.

"What are my other options?", I said

There were no other options, I was told.

She recommended I give a copy of my discharge orders to the patient and for him (he's 85 years old) to call his doctor on Tuesday and let him know what orders he needs to enter.

I said, that is unacceptable. I will not place responsibility for followup care on the shoulders of an 85 year old retired farmer, who has no idea what labs he needs, and what meds need to be addressed.

I should have a right. I should demand a right to speak with a physician regarding my discharge plans and discharge needs of THEIR primary patient.

Instead, in the spirit of government run, not my problem mentality (which the secretary readily admitted to), I am told I have no other options. He can drive 3 hours out of his way, or he can call his doc on tuesday to tell his doc what I write on a discharge summary.

I asked for a fax number of the docs office. There is none. I asked for a phone number. There is none.

Ultimately, I asked for the number of the VA doctor we have been asked to call should we ever run into any problems. Of course. Voice mail. I left a very long voice mail, describing exactly what I needed ordered for my patient. I expect him to enter ever single order, despite it not being his personal patient.

My responsibility is to speak with the referring physician. When I have exhausted all attempts, the VA is to blame by setting up barriers to my care and the patient's care.

And guess how much Medicare will pay me for my 45 minutes on the phone for all this Bullshit clerical work that I tried to overcome.

Zilch. Zero. Nada.

I then sent off a letter to the VA doc, the CMO of the state VA hospital, the director of my group, detailing exactly how the VA is obstructing my ability to provide adequate verified followup care for an 85 year old man on coumadin, and a recent GI bleed.

It is a functionally illiterate communication system.


It is unacceptable that I must discharge a patient out into the wild with necessary followup and have no physician to physician contact to verify followup needs and plans are adequately addressed.

THAT's a shining example of the delivery aspect of VA medicine for you.