Arkansas health care providers who are owed tens of millions of dollars by the U.S. Department of Veterans Affairs say there has not been a marked improvement in receiving payments since they met with VA leaders more than two months ago to discuss their concerns.
But the VA says a recent realignment of the department's business operations will lead to more prompt processing of claims, and the American Hospital Association, which has taken up the matter after hearing complaints from providers nationwide, is hopeful.
"There has been great concern," said Robyn Bash, senior associate director of the American Hospital Association. "That is something the Veterans Administration is aware of."
In April, U.S. Sen. John Boozman, R-Ark., arranged a meeting in North Little Rock for representatives from the 60 hospitals and other health care centers in Arkansas that reported having outstanding claims with the VA. Paul Cunningham, executive vice president of the Arkansas Hospital Association, surveyed about 35 of the hospitals that together accounted for about 4,400 in unpaid claims worth an estimated $24 million.
The lack of payment is putting financial strain on some of the state's health care providers, one of which reported having to deny care to VA patients.
"Wish I could tell you that there's been some marked improvements since the meeting, but that's not the case," Cunningham said in an email. "Although, we said at the time that this would be a process."
Claims are filed by health care providers seeking reimbursement for care that they provide to VA patients. A VA patient may receive care at a non-VA facility in emergency cases when a VA hospital can't be reached in time; if VA facilities can't treat the patient in a timely manner; or if the patient needs a specialist that the VA hospital does not have on staff.
After it was reported last spring that veterans had died while waiting for care at the Phoenix VA hospital and that some facilities manipulated data to conceal how long veterans were waiting for care, the VA allowed more veterans to seek private-sector treatment through an effort called the Accelerated Care Initiative.
The initiative, which started May 21, 2014, led to "tremendous growth" in the number of claims from non-VA providers and, subsequently, to delays in getting them processed, said Gene Migliaccio, the VA's deputy chief business officer for purchased care. He spoke during a U.S. House Committee on Veterans Affairs hearing June 3.
Migliaccio testified in the hearing -- which was held to assess the VA's ability to promptly pay non-VA health care providers -- that from January through April, the VA received 34 percent more claims from non-VA health care providers than during the same period last year.
But some Arkansas hospitals reported experiencing delays in payments of far longer.
'Absolutely a fiasco'
Vince Leist, the president and CEO of North Arkansas Regional Medical Center in Harrison, testified at the June 3 hearing on behalf of the American Hospital Association.
The North Arkansas Regional Medical Center, which includes a 174-bed hospital in its system, has 215 unpaid VA claims -- some 4 years old -- worth approximately $750,000. The hospital receives payments from the VA only sporadically, Leist said.
"They're obviously overwhelmed," he said. "We send claims in, and they request medical records. We send those in, and they lose them. It's just absolutely a fiasco."
Dan Eckles, chief financial officer of Washington Regional Medical Center in Fayetteville, said in an email that his 270-bed hospital has about 500 outstanding VA claims worth $2.3 million. More than one-third of those are more than 6 months old, he said, and approximately $160,000 worth of the claims date back two years.
The hospital has submitted another 140 claims worth $750,000 that it's waiting for the VA to deem eligible to receive reimbursement.
McGehee-Desha County Hospital, a 25-bed critical access facility in McGehee, has unpaid claims worth $80,000 to $100,000, said hospital president and CEO John Heard.
"It's very disappointing," Heard said. "For them not to pay claims in a timely manner and leave us hanging out there with several thousands of dollars worth of claims -- or in some cases millions -- that's just unacceptable."
Bash said the problem extends beyond Arkansas, and it's hard to quantify.
While the American Hospital Association does not have statistics on outstanding VA claims, she said, it has received anecdotal information over the years from hospitals nationwide about the lack of timely pay.
"I think, by and large, hospitals and health systems are a little more patient with the VA system because it is geared toward serving veterans," Bash said. "However, there is a breaking point where there are claims -- quite substantial in value -- and there isn't payment. So, frustrations build, and that's often the time when we'll be asked to be of assistance in some capacity."
The association, which lobbies on behalf of its nearly 5,000 member health care facilities, wrote a letter to VA Secretary Robert McDonald in March that included a request for hospitals to get prompt reimbursements.
'We are hopeful'
American Hospital Association leaders hope the VA is on its way to establishing a timely and efficient payment system, especially after a recent reorganization of its business operations, Bash said.
The Veterans Access, Choice and Accountability Act signed into law in August was a $16.3 billion VA overhaul. As part of that law, the VA's chief business office was given oversight of the country's 21 Veterans Integrated Service Networks, where each region's payment center is located.
Most of Arkansas falls under the South Central VA Health Care Network based in Pearl, Miss. That network also covers Louisiana and parts of Oklahoma, Texas, Mississippi, Alabama and Florida. Some of east Arkansas is part of the VA Midsouth Healthcare Network in Nashville, Tenn., and a few counties in northeast Arkansas are in the VA Heartland Network, based in Kansas City, Mo.
Joe Enderle, director for purchased care at the VA's chief business office, said the additional oversight would create better standardization for how claims are processed and paid.
"We are hopeful that a more centralized approach may help in providing more timely payment," Bash said. "We haven't seen that just yet, but we are hopeful that [it] is forthcoming."
After working with the VA's chief business office since the April meeting, Anita Deason, Boozman's military and veterans liaison, and Becca Caldwell, a caseworker in the office, said they are also optimistic, but the process will take time.
"No one can fix a problem this big overnight. This has gone on for years," Deason said. "This is a journey. It's going to take many steps to get there."
In the past two months, a few hospitals have reached out to Boozman's office seeking help in learning the status of their claims, Deason said. She and Caldwell have mediated between those hospitals and the VA, and 3-year-old claims are now moving through the system.
As a result of the meeting with Arkansas health care providers, the VA has taken other steps to make fixes on a broad scale, Enderle said.
It set up a new call center for the South Central VA Health Care Network at the end of April that will be a model for other networks in the country.
And, after hearing from Arkansas hospitals about problems with sending in medical documentation to accompany claims, the VA has improved the process for how those documents are stored, said Holly Shryock, who helps oversee the South Central network.
Health care providers at the April meeting also told Enderle and Shryock that the call center limited hospitals to only inquiring about three claims per call. That rule has been eliminated.
A long-term goal -- and something Arkansas hospitals asked for -- is the creation of an online portal where providers can see the status of their claims, Enderle said.
"That will take some time before it's implemented," Enderle said. "But we are pursuing that."
For now, the VA is reaching out to some hospitals via phone with regular updates on the status of their claims.
'A little better'
In his testimony earlier this month, Migliaccio said the recent actions "have had a significant impact in processing volume," especially in the South Central VA Health Care Network.
In December, slightly more than 35 percent of claims in the network were paid within the VA's timeliness goal of 30 days. In May, 82.13 percent of claims reached the goal, Migliaccio said.
Some Arkansas hospitals are seeing the effects of the changes.
Washington Regional Medical Center receives, on a regular basis, a form indicating which claims have problems and need to be resubmitted, Eckles said. The hospital is also able to contact the VA more easily.
But there are still problems with having to resend documents, and Eckles said the process is "cumbersome" to find out whether a veteran is eligible to receive private-sector care on the VA's dime.
Communication with the VA claims processing center has been "a little better" at the North Arkansas Regional Medical Center since the April meeting, Leist said. But one staff member -- whose only duty is to track VA billing -- remains on hold for hours at a time when she calls VA representatives.
Heard said his rural hospital has seen no change since the April meeting. He cited instances when hospital employees were on hold with a VA representative for 30-45 minutes before the call was disconnected.
To address each hospital's problems, Boozman's office is planning a follow-up meeting in Arkansas in August. Enderle said he wants to have a team of four staff members who could sit down with health care providers to go through their claims.
"We recognize that there's a problem, and we recognize we need to fix that problem," Enderle said.
'Float the costs'
Lori Williams, the owner of Fort Smith-based Christian Companion Senior Care, an in-home care service, said during the April meeting that she dropped VA patients as clients last August because she was not receiving payment for their care.
Williams said at the time that her small business had unpaid claims dating back to 2012 worth about $70,000.
Bash said she had not heard of another health care provider that has been forced to stop accepting VA patients, but the unpaid claims have caused concern.
"Certain facilities are able to float the costs of care far better than others. It just depends on their financial situation," she said. "They really try to float that as best as they can for as long as they can. But they have to make payroll. They have to pay their bills. Cash flow becomes a very important part of their financial wherewithal."
Leist said the North Arkansas Regional Medical Center would continue to accept VA patients, but the nonpayment may force the medical center to reduce what it offers to all patients.
Currently, the center has a 174-bed hospital, three rural clinics, six primary-care clinics and hospice, home health, urgent care and ambulance services.
"For example, our hospital offers lifesaving ambulance services to four counties in rural Arkansas with no support from tax dollars, but those services could be scaled back or eliminated," he testified at the House committee hearing. "Many hospitals throughout the country would have to make similar decisions, resulting in decreased access to care for patients and communities."
The McGehee hospital will also continue to accept VA patients, Heard said, though it puts the hospital "between a rock and a hard place."
"We're going to take care of our veterans -- of anyone who shows up at our door. It's just a bad situation," Heard said. "Nobody wants hospitals not to be paid."
SundayMonday on 06/21/2015