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One VA...NOT

Reprinted from PN December 2012

VA should stop bickering about who pays for what and provide quality service.

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We are aware of the Department of Veterans Affairs (VA) claim that we are “one VA” encompassing all the VA facilities around the country. I must admit to having some serious reservations about that claim. 

The country is broken down into 21 Veterans Integrated Service Networks (VISN). Each VISN is responsible for all the veterans’ needs in their designated area. They submit and are granted a budget to cover the cost of providing for that care. Their respective budgets are combined and approved by Congress as one VA budget request. Once that takes place, the VA Central Office breaks it down into the 21 individual budgets. 

Unfortunately, when these 21 VISNs were created, it caused a situation where we deal with 21 separate business plans, creating a virtual headache for Paralyzed Veterans of America (PVA). We, basically, aren’t dealing with “one VA” anymore. The 21 VISN directors make their decisions on healthcare and prosthetic needs based on their yearly business plan.

You may ask why this should cause us concern. Let me use the example of a spinal-cord-injured veteran who lives in VISN A and has received some care in VISN B because VISN A doesn’t have a spinal-cord injury (SCI) center.

This veteran is ready for discharge from the hospital, but with the veteran’s medical complications the SCI center in VISN B has determined that certain medical equipment must be put in his home. This seems easy enough to accomplish, right? Not so fast! 

This veteran lives in VISN A, and VISN B is requiring the purchase of equipment. VISN A is arguing about who is paying for it. “After all, VISN B, you are the ones who want this equipment, not us.” So much for “one VA!”

This unfortunate veteran is caught between two separate VISN directors’ spat over budgetary matters. While they fight, the veteran remains as an inpatient at a cost of approximately $900 a day. Makes perfect sense, wouldn’t you say? 

We all know the answer; this is nothing short of wasteful spending. Why has neither director thought about providing the equipment so this veteran can go home, and then fight about who pays for it later? Ain’t gonna happen!

Let’s look at my own scenario. While it’s not on the scale of the above mentioned veteran, I can provide firsthand knowledge.

 I live in Oklahoma and receive my care at the Oklahoma City VA Medical Center. There is no SCI center in the state, so an SCI Primary Care Team has been established at the Oklahoma City VAMC. According to the VHA Handbook on SCI Care in the VA system, it is recommended that all SCI veterans receiving care at a non-SCI center schedule their annual comprehensive health evaluation at an SCI center.

Oklahoma City is in VISN 17. The SCI “hub” for VISN 17 is Houston. In between Oklahoma City and Houston are SCI centers in Dallas and San Antonio. It didn’t make sense to travel from my home in northwest Oklahoma to Houston for my “annual.” So, I went to Dallas, which is much closer but located in VISN 16.  

While having my “eval,” it was determined I needed a new wheelchair. The SCI center in Dallas ordered it for me. I have had this chair for several years. Eventually the casters on the chair were worn out and needed replacing.

When I approached the VISN 17 VA Prosthetics Department, I was told I would have to get the parts from the VA that ordered
that chair. Oops! 

What happened to “one VA”? Why not avoid the inconvenience of my wheelchair breaking down, provide the service and argue about who is going to pay for it later? Perhaps, the answer to these situations is to centralize the budget. Come on VA! Stop bickering about who pays for what and provide the quality of service we all expect.   

As always, please make time to visit a hospitalized veteran today. Remember those in long-term-care facilities as well. 

 

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One VA...NOT

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