MTPR

Montana Hospitals: New VA Program Fails To Pay

Apr 19, 2016

This week we’re reporting on a year-old program for veterans that’s supposed to make it easier for them to get health care. It’s called Veterans Choice, and yesterday we heard widespread agreement that it’s not working as Congress intended. Frustration with Veterans Choice in Montana became evident in February, when Senator Jon Tester held 28 meetings across the state to get vets' feedback on it.

Veterans Choice is supposed to let vets who live more than 40 miles from a VA health facility get care at nearby private clinics instead, with the VA picking up the tab.

"We were the first facility to provide services through the Choices [sic] Program," says Ron Gleason, CEO of Mineral County Hospital in Superior.

"We provided our first services to a veteran on September 9, and we have not been paid for the services since that time. So we have not been paid for any Choices services," he says.

Ron Gleason is CEO of Mineral County Hospital in Superior
Credit Courtesy Mineral County Hospital

Gleason’s hospital is not alone. Across the country doctors, clinics and hospitals say they’re either not getting paid for taking care of veterans, or only getting paid after months of waiting and slogging through time-consuming paperwork. A lot of them, like Gleason, are just plain giving up.

"I don’t think we've been providing any services here recently, because we’re not seeing anybody getting paid," he says.

Gleason says there are a lot of veterans in Mineral County, and his hospital does its best to get them healthcare without them having to drive hours to VA facilities in Missoula or Helena. They host a mobile clinic from the VA once a month, but his non-profit hospital runs on a shoestring budget, and can’t afford give away services or wait months to get paid.

Air Force veteran Tony Lapinski lives in Superior. He says he thinks the word is out about Choice’s record of paying doctors. He struggled for weeks to get an appointment with a non-VA specialist relatively close to home, and then:

"I got the impression in the neurosurgeon’s office that I was something slightly lower than a doormat," Lapinski told University of Montana Journalism School Student Dominique Giusti.

But the 46-year-old Superior resident says he can understand why doctors are giving up on Veterans Choice.

Tony Lapinski is an Air Force veteran who lives in Superior. He's experienced frustrations trying to use Veterans Choice to see specialists for problems with his back.
Credit Dominque Giusti

"I tried to put myself in his shoes," Lapinski said. "I used to mechanic on the side quite a bit. I had a list of slow pay customers and they were either a hot check or a slow pay and when I mean slow pay, I mean over 90 days, I might work for them again but everybody else came before them. So why would it be any different with these health care professionals?"

The Veterans Administration itself doesn’t pay non-VA doctors and hospitals through the Choice program. It has a couple of private contractors that do it. The one that serves Montana is called HealthNet, and Senator Tester blames them for most of the problems with Choice.

"The payment to the providers is just laziness," Tester says. "I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick. And so, I’m just not a big fan of HealthNet."

We’ve been trying to get an interview with HealthNet since the first of March. A company spokesman says the company just completed a merger, and their CEO is too busy to talk to the press. No other HealthNet officials are available for interviews.

HealthNet CEO Billy Maynard testified before the U.S. House Veterans Affairs Committee March 3. He said recent work to change payment procedures through Choice is already paying off.

"We’re all very convinced and already have evidence that those providers who were challenged by the more complex payment methodologies are already seeing very significant relief in the three weeks after that modification," Maynard told the committee. "I think we expect all providers to be current very expeditiously as we move into the spring."

The Veterans Administration has a hard time tracking how many providers have given up on Choice, so it’s hard to say if the changes HealthNet’s Maynard talked about are luring many back.

But in Montana, the network of 12 hospitals affiliated with Billings Clinic hasn’t signed on to the Choice program, nor has it indicated an interest in doing so after the recent changes.

"The biggest health care provider in the state of Montana won’t deal with Choice. That should tell you something’s wrong with the program," Senator Tester says. 

The Senate Veterans Affairs Committee Senator Tester sits on is working on legislation to fix the Choice program. They’re merging Democratic and Republican proposals with the goal of getting something passed before Memorial Day.

Tester says he’d like the legislation to let states opt out of using private companies like HealthNet to help veterans coordinate care with doctors and clinics close to home that aren’t part of the VA system.

Jon Tester is a member of the Senate Committee on Veterans Affairs
Credit PD

"I believe it’s better done in a rural state like Montana by the VA," Tester says. "I can’t speak for Detroit or Miami or Houston or wherever, but I can tell you in a state like Montana, and I know the Montana VA, they can be that administrator, and they can do a much, much, much better job, and that’s why this bill was drafted, to give them the flexibility to do exactly that."

At the same time Congress is working on a fix, the VA and HealthNet continue to work together to try to improve the Choice program.

Back in Superior, veteran Tony Lapinski is just hoping that he’s able to get in to see the doctors he needs in time.

"Some days I wake up and go, 'Am I wasting time, when I could be on chemotherapy or getting a surgery to get this thing out?'" Lapinski says. "Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, 'boy that’s cancer! If you had come in here six months ago we probably could have done something for ya, but its too late now.'"

This story was produced with reporting assistance from Dominique Giusti, and Carrie Miller, who are students and the University of Montana School of Journalism.

The story was made possible, in part, by a grant from the Montana Health Care Foundation.