Fix Payment to Improve Veterans' Health Care, AAFP Tells VA

Agency's Proposed Rule Would Affect Care, Workforce, Pipeline

April 09, 2019 03:57 pm News Staff

The Department of Veterans Affairs (VA) can help veterans access health care by increasing payment for primary care services delivered outside the VA system and expanding graduate medical education (GME) offerings, the AAFP told the agency recently.

[veterans health application for health benefits]

"Family physicians have a great opportunity to provide care, but enhanced compensation is needed to ensure an adequate workforce," the Academy said in a March 22 letter(2 page PDF) to VA secretary Robert Wilkie.

The letter, signed by Board Chair Michael Munger, M.D., of Overland Park, Kan., was the Academy's response to the Veterans Community Care Program proposed rule(www.govinfo.gov) that was published Feb. 22 in the Federal Register.

The proposed regulation would establish criteria for determining when covered veterans could receive hospital care, medical services and extended-care services from non-VA entities.

Noting that many veterans receive care from family physicians and other primary care physicians outside the VA system -- a physician workforce that, like the VA's, is compromised by shortage, especially in rural areas -- the Academy advised the agency to improve access to care through work on two fronts: It should expand GME offerings "with a focus on family medicine, primary care, mental health and physician shortage areas," and it should improve payment.

"The AAFP strongly believes that Veterans Community Care Program payments must be above current Medicare levels to be effective in promoting access to primary care services for veterans, spouses, children, survivors and certain caregivers of veterans who meet eligibility criteria," the letter said.

The AAFP pointed out that any health care contract -- public or private -- that does not at least meet the Medicare payment rate "creates an unmanageable financial drain for most family medicine practices," which already operate on extremely thin margins.

"If the VA offers contracts at less than the Medicare rate, the AAFP is concerned that most practices will not be able to participate in the program, which undermines the goal of expanding access to these important services."

Citing the Medicare Payment Advisory Commission's June 2018 report(medpac.gov) to Congress, the AAFP pointed out that the Medicare physician fee schedule already undervalues evaluation and management (E/M) services -- those provided most often by family physicians.

"This mispricing," the commission wrote, "may lead to problems with beneficiary access to these services and, over the longer term, may even influence the pipeline of physicians in specialties that tend to provide a large share of E/M services."

The VA can push back against this possibility, the Academy told the agency.

"The VA should offer contracts at levels above the current Medicare rate for E/M services, especially office visits, so family physicians and other non-VA primary care physicians can afford to treat veterans," the AAFP wrote.

Related AAFP News Coverage
Leader Voices Blog: Better Health Care for Veterans Requires Better Payment
(2/18/2019)

Study: Veteran Care a Unique Challenge to Non-VA Primary Care
'They Are Their Own Culture,' One Surveyed Physician Says

(2/5/2019)

Change Doubles Number of Vets Eligible for Care Outside VA
(3/25/2015)

More From AAFP
In the Trenches blog: Are Family Physicians an Answer to VA's Primary Care Crisis?
(7/15/2014)