Survey of Selected Veterans Administration Fee-Basis Programs

A study was conducted of the Veteran's Administration (VA) fee-basis program at selected VA hospitals to evaluate the management of selected fee-basis medical services and to determine if any of the services provided on a fee basis could be performed by the VA. Veterans who are eligible for outpatient fee-basis treatment are issued a VA Outpatient Medical Treatment Information (ID) card. VA monitoring of the ID card program is inadequate, and as a result, staff of VA hospitals and outpatient clinics do not routinely know whether patients who were issued ID cards remain eligible for private medical treatment at VA expense. Fee-basis dental costs could be reduced if VA hospitals performed more dental work in-house. Some VA hospitals' methods of recording the costs of fee-basis services are incorrect and inconsistent, and providers are often overpaid for the fee-basis services they render. There is a need for cost limitations for certain automobile adaptive equipment, including citizens' band radios. The Administrator of Veterans Affairs should: (1) establish a system for monitoring the initial authorization and continued need for ID cards which would include, as a minimum, requiring periodic medical reports from private practitioners and cyclical redeterminations of fee-basis eligibility; (2) evaluate dental services available in VA hospitals and those needed based on work load demands; (3) develop a standardized fee-basis guide for charging specific inpatient fee-basis procedures; (4) direct a study to determine the extent of fee-basis overpayments and take appropriate corrective action; and (5) establish limitations for reimbursing disabled veterans for citizens' band radios installed in automobiles.