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Started By
Message
1
Posted on 1/22/17 at 1:04 pm to DisplacedBuckeye
quote:
Any thoughts on the effectiveness of the VA and what can be done to improve it?
Accountability, first and foremost. The wait time scandal is most striking for how many people lied, and how few were fired as a result (9 I think aside from Shinseki, who stepped down). They need real, believable, and trackable goals / metrics. At the moment, I doubt they even know what's broken at the facility level in a credible way to drive improvements.
Second, I think there's some benefit to the Choice program, but more because the rigidity of the VA system (and honestly scarcity compared to the HC system as a whole) creates problems for vets. There's a place for small trial programs to see what works - would some veterans accept a block grant to buy a private insurance plan on the exchange market, and forgo VA care? Not everyone who has VA coverage needs the specialized, small-population care that the VA would lose if it were privatized. But doing that for everyone would draw too many patients away and might cross some unknown viability threshold that the VA requires to maintain adequate care to those who seek it.
As someone who's used the VA (you've mentioned you're a vet if I recall?), what would you like to see change? What would you consider indispensable at the VA, that only they can provide? What do they do well that we in the larger HC industry could adopt?
Posted on 1/22/17 at 1:24 pm to BamaAtl
quote:
As someone who's used the VA (you've mentioned you're a vet if I recall?)
Yeah, I have a permanent medical retirement with 100% rating.
quote:
what would you like to see change?
The process of getting nearly anything accomplished is completely bogged down. I'm currently working with a VSO to get another issue service-connected, and it's the biggest waste of time. Veterans with real issues are being ignored and seeing claims denied, while others that know the right people cruised right through the system and are getting 70% or higher ratings for things that are bullshite in my opinion. There is a lot of abuse in the system that I think needs to be weeded out.
quote:
What would you consider indispensable at the VA, that only they can provide?
Compensation, and that's probably about it.
quote:
What do they do well that we in the larger HC industry could adopt?
My experience has been largely negative, so I'm not sure it'd be a good idea to adopt anything from the VA.
Posted on 1/22/17 at 6:40 pm to DisplacedBuckeye
quote:
Veterans with real issues are being ignored and seeing claims denied, while others that know the right people cruised right through the system and are getting 70% or higher ratings for things that are bullshite in my opinion. There is a lot of abuse in the system that I think needs to be weeded out.
I've been largely disappointed with VA staff in the interactions we've had with overlapping patients - though to be fair, if we have an overlapping patient they usually have a very acute illness with a variety of comorbidities. It seems that the Peter Principle is in full force there, much like other organizations built on bureaucracy over merit. My concern about cleaning house is the institutional knowledge that some of those entrenched individuals have. A bit of a catch-22, but there would have to be some very strong accountability measures adopted to bring them in line.
quote:
Compensation, and that's probably about it.
So something like block-granting care to veterans to purchase health insurance? Or more along the lines of reimbursing for costs? Or even both?
Btw, when you asked about my experience dealing with VA billing, is there a specific issue you or someone is having? I'd be happy to send a question/request up the food chain at the Atlanta VA, but will admit my contacts there are mostly physicians and vastly over-represented on the research side rather than full-time patient care.
Posted on 1/22/17 at 7:35 pm to BamaAtl
quote:
I've been largely disappointed with VA staff in the interactions we've had with overlapping patients - though to be fair, if we have an overlapping patient they usually have a very acute illness with a variety of comorbidities. It seems that the Peter Principle is in full force there, much like other organizations built on bureaucracy over merit. My concern about cleaning house is the institutional knowledge that some of those entrenched individuals have. A bit of a catch-22, but there would have to be some very strong accountability measures adopted to bring them in line.
My experience is almost entirely from the perspective of the customer. I was "fortunate" enough to have been forced out, so my medical issues have been covered. I have several friends that separated after their enlistments ended who have had nothing but problems with claims. I work with a lot of veterans, personally and professionally, and the things I hear sickens me.
quote:
So something like block-granting care to veterans to purchase health insurance? Or more along the lines of reimbursing for costs? Or even both?
Nope, just disability pay. I think they're incompetent with handling claims, but they're at least able to manage sending out the money.
quote:
Btw, when you asked about my experience dealing with VA billing, is there a specific issue you or someone is having?
Yeah, I'm currently working on getting something service-connected with no diagnosis while in-service. I have statements from others who witnessed the symptoms. I was just wondering how the medical opinion works for that. I have an appointment with my doctor set up. Was just curious.
Posted on 1/23/17 at 10:44 am to DisplacedBuckeye
quote:
I'm currently working on getting something service-connected with no diagnosis while in-service. I have statements from others who witnessed the symptoms. I was just wondering how the medical opinion works for that. I have an appointment with my doctor set up. Was just curious.
I'll send a few emails to colleagues at the VA and see if they have any guidance. One's in Mental/Behavioral health, so I can't imagine he's never seen this before.
Will let you know in this thread if they have any advice.
Posted on 1/23/17 at 4:27 pm to BamaAtl
OK, cool. Not a huge deal. The VA people have been pretty knowledgeable about some of it.
Posted on 1/23/17 at 9:10 pm to DisplacedBuckeye
quote:
The VA people have been pretty knowledgeable about some of it.
The advice I received was to bypass the physicians altogether and head to the patient advocate's office. He said they deal with this all the time and should be able to streamline the process.
Additionally, if that doesn't work send a letter to the director of the specific hospital and your congressmen. But the way he said it made it sound like the standard reply they give for this sort of concern, so probably what you've already heard.
Posted on 1/23/17 at 9:23 pm to BamaAtl
Yeah, I've been told to go speak with them about it. Pretty much what your contacts said. I'm weary of that, though. I don't have anything in my medical records for this diagnosis, so I'll have to rely primarily on statements and a medical opinion to connect it.
Posted on 1/24/17 at 8:36 am to DisplacedBuckeye
Medical opinion shouldn't be terribly difficult, depending on the doctor - and the patient advocacy office should be able to help with that.
I don't know any colleague who would have a problem giving the opinion that a condition existed at a certain time with patient statements, supporting statements, etc, unless it was something specifically tested for with a negative result (say Hep C, but again I'm usually thinking in ID terms).
And I know there's probably some hesitancy, but this is definitely the kind of thing that constituent services office of your Congressman / Senators would be able to streamline. They love looking like they made a difference, and this may be something they can solve with a few calls.
I don't know any colleague who would have a problem giving the opinion that a condition existed at a certain time with patient statements, supporting statements, etc, unless it was something specifically tested for with a negative result (say Hep C, but again I'm usually thinking in ID terms).
And I know there's probably some hesitancy, but this is definitely the kind of thing that constituent services office of your Congressman / Senators would be able to streamline. They love looking like they made a difference, and this may be something they can solve with a few calls.
Posted on 1/24/17 at 4:56 pm to BamaAtl
OK, that's what I was wondering. The symptoms my doctor wrote in his diagnosis are nearly identical to what others saw while I was in, so hopefully my doctor can write an opinion that bridges that gap.
Thanks for the help, btw. Maybe I'll give you less shite from now on. Maybe.
Thanks for the help, btw. Maybe I'll give you less shite from now on. Maybe.
Posted on 1/24/17 at 7:09 pm to DisplacedBuckeye
quote:
Maybe I'll give you less shite from now on.
Do that, and they'll call you a collaborator or whatever crazy alt-right term is en vogue this week. Then they'll dig up our hidden thread.
Good luck!
Posted on 1/24/17 at 7:50 pm to BamaAtl
In that case...
Wrong.
Wrong.
Posted on 1/26/17 at 6:22 pm to BamaAtl
You still checking this?
Posted on 1/27/17 at 9:18 pm to DisplacedBuckeye
quote:
You still checking this?
It got lost for a minute but yeah.
Sad day today for American values.
Posted on 1/27/17 at 11:50 pm to BamaAtl
Yeah, Trump is doing what his supporters wanted. So much for hoping some of it was all talk.
Posted on 1/29/17 at 8:56 am to DisplacedBuckeye
quote:
Trump is doing what his supporters wanted. So much for hoping some of it was all talk.
Not terribly shocked that he's an actual racist, and doesn't just play one on tv.
The one shining light is he's incompetent, so he just handed a year's worth of birthdays to the ACLU. They're going to eviscerate him in every court they want to file over this thing.
Posted on 1/29/17 at 1:15 pm to BamaAtl
It's just incredible to me how these patriotic conservatives support things that go against what we are as a country.
Medical related question for you. How much weight do you typically give a patient's statement on pain? For example, I've been dealing with pain for a few years, but I've never sought treatment. It started when I was still in the Marine Corps, and I mentioned it in my final physical. They marked it down and noted that I was not currently bothered by it. It comes and goes, but recently has started bothering me more. I plan to go to my doctor, but I think I'll have a hard time connecting it because I sucked it up for the last few years.
Medical related question for you. How much weight do you typically give a patient's statement on pain? For example, I've been dealing with pain for a few years, but I've never sought treatment. It started when I was still in the Marine Corps, and I mentioned it in my final physical. They marked it down and noted that I was not currently bothered by it. It comes and goes, but recently has started bothering me more. I plan to go to my doctor, but I think I'll have a hard time connecting it because I sucked it up for the last few years.
Posted on 1/30/17 at 7:01 am to DisplacedBuckeye
quote:
How much weight do you typically give a patient's statement on pain?
Depends on the patient and whether it's suspected that they're just trying to get pills. I think in your situation an explanation similar to the one you gave, where it's been there but manageable but now is less so would likely be enough. Don't be surprised if they try to steer you away from any sort of opioid as a response - we're all hyper-aware of the growing abuse epidemic.
quote:
It's just incredible to me how these patriotic conservatives support things that go against what we are as a country.
Literally in the First Amendment about religion, but we're all cool with when Trump throws it away because he's going to lower taxes. Such jokes.
Immigration and diversity are as much a part of who we are as anything else.
Posted on 1/30/17 at 6:38 pm to BamaAtl
quote:
Don't be surprised if they try to steer you away from any sort of opioid as a response - we're all hyper-aware of the growing abuse epidemic.
I hope they do. I'm not a fan of the way I feel when I'm doped up.
All I'm looking for is a medical opinion to connect what I'm experiencing now to what is in my service medical records.
quote:
Literally in the First Amendment about religion, but we're all cool with when Trump throws it away because he's going to lower taxes. Such jokes.
I don't know if there's a line Trump could cross with some of these people. As a Republican (barely these days), it's embarrassing to see some of the shite people give him a pass on.
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