Do It Now!

Civilian healthcare providers are being pressed to tighten up. Veterans can't wait until they have a medical problem to establish their entitlement to treatment.

The Patient Protection and Affordable Care Act (PPACA) that passed in March 2010 is now being phased in. Veterans who have used community health-delivery facilities outside VA will find it increasingly difficult to access such services. 

I’ve mentioned that Paralyzed Veterans of America (PVA) does not engage or participate in partisan political activities. Our policy is to deal only with veterans issues. This editorial is intended to stay within those parameters and explain and give examples of why the VA health-delivery system is going to become more and more important to veterans, particularly those of us who have spinal-cord injuries (SCI).

Following are some examples I personally know of that illustrate how the civilian healthcare providers are being pressed to tighten up:

 - An SCI veteran was experiencing symptoms of autonomic dysreflexia (AD) with a blood pressure of 207/105 and in severe pain. His aide took him to the emergency room of a well-known hospital in his area. After the veteran gave the physician his medical information and spent about five hours in the ER, a case management nurse said she had to discharge him because she could find “no qualifying medical criteria” for admission in the three manuals they now had to use to justify hospital admissions.

 - An even more egregious example is of a man who lived in Alaska and had a malignant brain tumor. His physician had done all he could for him. Finally, having exhausted all the services available in that state, the doctor wrote a four-page letter to Medicare to justify the man’s transfer to Seattle for access to specialized surgical facilities that could possibly cure him. Medicare refused the request simply because the physician’s letter failed to include the statement “Required medical services not available in the local area.”

 

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