VA Needs Better Control Over Its Payments to Private Health Care Providers
HRD-85-49
Published: Aug 28, 1985. Publicly Released: Aug 28, 1985.
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Highlights
The Veterans Administration (VA) provides health care to most veterans at its own facilities; however, when circumstances prevent veterans from traveling to VA facilities, VA authorizes them to obtain care from private health care providers. GAO evaluated the VA system for determining how much to pay private health care providers.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Veterans Administration | The Administrator of Veterans Affairs should direct the Chief Medical Director to use CHAMPUS fee schedules as the temporary basis for paying private physicians and other health care providers for care provided to eligible veterans. |
Closed – Not Implemented
VA tested the implementation of this recommendation at two medical centers and found that it increased costs from 19 to 213 percent. Based on the test results, VA considers this recommendation too costly to implement.
|
| Veterans Administration | The Administrator of Veterans Affairs should direct the Chief Medical Director to use the more precise Medicare fee schedules once the automated claims processing system is fully developed. |
Closed – Not Implemented
The Medicare fee schedule is based on a survey of physician-billed charges. Insurance companies contracted to maintain the system annually rank physician charges and choose the 80th percentile as the maximum allowable charge. As physicians continue to increase their charges, the maximum charge escalates. VA believes there is no incentive or means to control costs with this method.
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Topics
Comparative analysisHealth care cost controlHealth care servicesInternal controlsMedical feesMedicareVeterans benefitsVeterans hospitalsMedical proceduresVeterans